Provider Demographics
NPI:1316926280
Name:AUCOIN, GLENN R (M D)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:R
Last Name:AUCOIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3311 PRESCOTT RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3900
Mailing Address - Country:US
Mailing Address - Phone:318-443-7222
Mailing Address - Fax:318-443-7641
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 410
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-443-7222
Practice Address - Fax:318-443-7641
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA019006207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1917664Medicaid
LAE50498Medicare UPIN
LA5N213Medicare ID - Type Unspecified