Provider Demographics
NPI:1013991512
Name:LAVY, REBECCA JO (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JO
Last Name:LAVY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9377 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1504
Mailing Address - Country:US
Mailing Address - Phone:480-538-5440
Mailing Address - Fax:480-538-5439
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 319
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-538-5440
Practice Address - Fax:480-538-5439
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG929865Medicare UPIN