Provider Demographics
NPI:1477845667
Name:COWAN, RENEE ANTONETTE (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANTONETTE
Last Name:COWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ANTONETTE
Other - Last Name:WOODBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 WOMAN'S WAY
Mailing Address - Street 2:PHYSICIAN PRACTICE MANAGEMENT
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817
Mailing Address - Country:US
Mailing Address - Phone:225-216-3006
Mailing Address - Fax:
Practice Address - Street 1:500 RUE DE LA VIE ST STE 515
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5129
Practice Address - Country:US
Practice Address - Phone:225-216-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA328024207VX0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program