MEDICARE: RENEE ANTONETTE COWAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207VX0201X	Gynecologic Oncology Physician	328024	LA

General Provider Information

NPI Number	:	1477845667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE ANTONETTE COWAN M.D.

Provider Business Mailing Address
First Line	:	100 WOMAN'S WAY
Second Line	:	PHYSICIAN PRACTICE MANAGEMENT
City	:	BATON ROUGE
State	:	LA
Zip	:	70817
Country	:	US
Telephone Number	:	225-216-3006
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 RUE DE LA VIE ST STE 515
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-5129
Country	:	US
Telephone Number	:	225-216-3006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	11/19/2024

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