Provider Demographics
NPI:1174730881
Name:ALDAVA, REBECCA R (PA)
Entity type:Individual
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First Name:REBECCA
Middle Name:R
Last Name:ALDAVA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1002 NE HIGHWAY 66
Mailing Address - Street 2:STE 2
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-9305
Mailing Address - Country:US
Mailing Address - Phone:580-928-2208
Mailing Address - Fax:580-928-2246
Practice Address - Street 1:1002 NE HIGHWAY 66
Practice Address - Street 2:STE 2
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-9305
Practice Address - Country:US
Practice Address - Phone:580-928-2208
Practice Address - Fax:580-928-2246
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-01-24
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Provider Licenses
StateLicense IDTaxonomies
OK1158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200047950AMedicaid
OK200047950AMedicaid
Q57320Medicare UPIN