Provider Demographics
NPI:1801293485
Name:REBECCA FAULKNER MD, PLLC
Entity type:Organization
Organization Name:REBECCA FAULKNER MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-601-6181
Mailing Address - Street 1:15804 SONADOR DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5819
Mailing Address - Country:US
Mailing Address - Phone:405-601-6181
Mailing Address - Fax:405-601-7012
Practice Address - Street 1:15804 SONADOR DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5819
Practice Address - Country:US
Practice Address - Phone:405-601-6181
Practice Address - Fax:405-601-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK43765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty