Provider Demographics
NPI:1508999178
Name:SAENZ, REBECCA BUCHANAN (MD, IBCLC, FABM)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:BUCHANAN
Last Name:SAENZ
Suffix:
Gender:F
Credentials:MD, IBCLC, FABM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1538
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1538
Mailing Address - Country:US
Mailing Address - Phone:601-898-7979
Mailing Address - Fax:601-898-7989
Practice Address - Street 1:111A DEPOT DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9395
Practice Address - Country:US
Practice Address - Phone:601-898-7979
Practice Address - Fax:601-898-7989
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12881207Q00000X
TNMD-021850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115032Medicaid
MSE75207Medicare UPIN