Provider Demographics
NPI:1336225952
Name:HARRIS, RENEE S (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:S
Last Name:HARRIS
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 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5126
Mailing Address - Country:US
Mailing Address - Phone:225-201-0505
Mailing Address - Fax:225-935-2190
Practice Address - Street 1:500 RUE DE LA VIE
Practice Address - Street 2:SUITE 310
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5126
Practice Address - Country:US
Practice Address - Phone:225-201-0505
Practice Address - Fax:225-935-2190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.017688174400000X
LA017688207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1353001Medicaid
LA1353001Medicaid
LAB63869Medicare UPIN