Provider Demographics
NPI:1336271006
Name:HUSTON, REBECCA (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HUSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HOSPITAL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2857
Mailing Address - Country:US
Mailing Address - Phone:740-594-7979
Mailing Address - Fax:740-594-5090
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:STE 200
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-594-7979
Practice Address - Fax:740-594-5090
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4208531Medicare PIN