Provider Demographics
NPI:1467490714
Name:BOYD WHITTEMORE, REBECCA LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEIGH
Last Name:BOYD WHITTEMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:BOYD
Other - Last Name:WHITTEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1990 INDUSTRIAL BLVD
Mailing Address - Street 2:SOUTH LOUISIANA MEDICAL ASSOCIATES
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7055
Mailing Address - Country:US
Mailing Address - Phone:985-873-1335
Mailing Address - Fax:985-873-1225
Practice Address - Street 1:1990 INDUSTRIAL BLVD
Practice Address - Street 2:SOUTH LOUISIANA MEDICAL ASSOCIATES
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7055
Practice Address - Country:US
Practice Address - Phone:985-873-1335
Practice Address - Fax:985-873-1225
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025607207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276536500Medicaid
LA1043966Medicaid
FLAC402ZMedicare PIN
FL276536500Medicaid