Basic Information
| Provider Information | |||||||||
| NPI: | 1538353594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHIDDON | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98509 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708849509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257692200 | ||||||||
| FaxNumber: | 2257682185 | ||||||||
| Practice Location | |||||||||
| Address1: | 10101 PARK ROWE AVE | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708101686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257692200 | ||||||||
| FaxNumber: | 2257682185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 03/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | R70608 | AZ | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | P4396 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 205869 | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | P01262315 | 01 | LA | RAILROAD MEDICARE | OTHER | 1007633 | 05 | LA | MEDICAID | 205869 | 01 | LA | MD LICENSE | OTHER |