Provider Demographics
NPI:1245211846
Name:GRAHAM, REBECCA (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3117 TERRACE PARK TRL
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7585
Mailing Address - Country:US
Mailing Address - Phone:816-805-1993
Mailing Address - Fax:
Practice Address - Street 1:3300 HEALTHPLEX PKWY
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-515-6615
Practice Address - Fax:405-515-3635
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS528059207V00000X
MO103674207V00000X
OK5743207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245211846OtherTRICARE
5135654OtherAETNA
KS100330060DMedicaid
2089570OtherUNITED HEALTH CARE
9181474OtherCIGNA
1245211846OtherCOVENTRY
29241057OtherBCBS
MOY36C605Medicare PIN
1245211846OtherTRICARE
KS130759Medicare PIN