Individual
DR. REBECCA R SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, UH 1501, INDIANAPOLIS, IN 46202-5149
(317) 948-0763
(317) 948-0503
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01063143A
IN
207Q00000X
Family Medicine Physician
11291
NH
208M00000X
Hospitalist Physician
Primary
01063143A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200855860
—
IN
05
—
30201716
—
NH
Enumeration date
06/16/2005
Last updated
09/17/2014
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