Provider Demographics
NPI:1992725915
Name:GREEN, REBECCA ANTEE (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANTEE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, SECTION OF CRITICAL CARE
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-8601
Mailing Address - Fax:318-675-8872
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS, SECTION OF CRITICAL CARE
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-8601
Practice Address - Fax:318-675-8872
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA0240942080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1105937Medicaid
LA4A703F600Medicare ID - Type Unspecified
LA1105937Medicaid