Provider Demographics
NPI:1396972865
Name:EARY, REBECCA LYNNE (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:EARY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 ERIE CT
Mailing Address - Street 2:SUITE 6160
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2566
Mailing Address - Country:US
Mailing Address - Phone:708-763-1490
Mailing Address - Fax:708-763-7232
Practice Address - Street 1:5939 HARRY HINES BLVD STE 303
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-2566
Practice Address - Country:US
Practice Address - Phone:214-645-3900
Practice Address - Fax:214-645-3901
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2020-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL125056753207Q00000X
TXS2576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-130684OtherIL MEDICAL LICENSE
IL036-130684Medicaid
TXS2576OtherTEXAS MEDICAL LICENSE