Provider Demographics
NPI:1518353671
Name:PISTORIUS, REBECCA E (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:PISTORIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 LINE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3841
Mailing Address - Country:US
Mailing Address - Phone:318-716-4610
Mailing Address - Fax:318-716-4690
Practice Address - Street 1:1111 LINE AVE FL 3
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3841
Practice Address - Country:US
Practice Address - Phone:318-716-4610
Practice Address - Fax:318-716-4690
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA3221412084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry