Provider Demographics
NPI:1104926591
Name:RUE, REBECCA R (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:RUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 N HIGHLAND AVE STE 530
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7390
Mailing Address - Country:US
Mailing Address - Phone:903-957-5437
Mailing Address - Fax:903-957-0456
Practice Address - Street 1:300 N HIGHLAND AVE STE 530
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7390
Practice Address - Country:US
Practice Address - Phone:903-957-5437
Practice Address - Fax:903-957-0456
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3807208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152026402Medicaid
OK200095080AMedicaid
TX8G9349Medicare PIN
OK200095080AMedicaid