Provider Demographics
NPI:1841597176
Name:TEBBOTH, TRICIA QUINN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:QUINN
Last Name:TEBBOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 BARBE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2352
Mailing Address - Country:US
Mailing Address - Phone:337-478-8744
Mailing Address - Fax:
Practice Address - Street 1:653 W 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2949
Practice Address - Country:US
Practice Address - Phone:318-636-8389
Practice Address - Fax:318-636-8389
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine