Provider Demographics
NPI:1821064635
Name:ALLARD, REBECCA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:ALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 POLE CREEK CROSSING
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2900
Mailing Address - Country:US
Mailing Address - Phone:308-254-5825
Mailing Address - Fax:
Practice Address - Street 1:1000 POLE CREEK XING STE 1
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2902
Practice Address - Country:US
Practice Address - Phone:308-254-5544
Practice Address - Fax:308-254-7258
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25260207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13424Medicare UPIN
KSI13424Medicare UPIN
KSI13424Medicare UPIN