Provider Demographics
NPI:1902048580
Name:MUELLER, REBECCA MCKAY (MD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MCKAY
Last Name:MUELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:MCKAY
Other - Last Name:LIETZOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-830-4060
Mailing Address - Fax:
Practice Address - Street 1:1332 S SHASTA AVE STE A
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8623
Practice Address - Country:US
Practice Address - Phone:541-732-5720
Practice Address - Fax:541-732-3403
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD178887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500712606Medicaid
IA39597OtherIOWA BOARD OF MEDICINE
PAMT193078OtherPENNSYLVANIA MEDICAL LICENSING BOARD
IAIB2621033Medicare PIN