Provider Demographics
NPI:1447273800
Name:GILES, REBECCA S (MD FAAP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S
Last Name:GILES
Suffix:
Gender:F
Credentials:MD FAAP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:S
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:201 FOURTH ST
Mailing Address - Street 2:BOX 30127
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-449-8600
Mailing Address - Fax:318-449-1461
Practice Address - Street 1:201 FOURTH ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-449-8600
Practice Address - Fax:318-449-1461
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021695207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA070013397OtherRAILROAD MEDICARE
LA1681768Medicaid
LA5W339Medicare ID - Type Unspecified
LA1681768Medicaid