Provider Demographics
NPI:1275891301
Name:TISDALE, REBECCA AUCOIN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:AUCOIN
Last Name:TISDALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:AUCOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 TULANE AVE., SL-50
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2699
Mailing Address - Country:US
Mailing Address - Phone:504-988-7809
Mailing Address - Fax:504-988-3971
Practice Address - Street 1:1430 TULANE AVE., SL-50
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2699
Practice Address - Country:US
Practice Address - Phone:504-988-7809
Practice Address - Fax:504-988-3971
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302396207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology