Provider Demographics
NPI:1427078401
Name:SHOAF, REBECCA WILLIAMS (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:WILLIAMS
Last Name:SHOAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:P
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:106 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2445
Practice Address - Country:US
Practice Address - Phone:864-797-9100
Practice Address - Fax:864-241-9239
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300088208000000X
SC36032208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC360326Medicaid
NC89137EHMedicaid
I11218Medicare UPIN