MEDICARE: DR. BEN THEBAUT 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	207XS0106X	Orthopaedic Hand Surgery Physician	ME20057	FL

General Provider Information

NPI Number	:	1255352787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEN THEBAUT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 11
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33468-0011
Country	:	US
Telephone Number	:	561-748-2889
Fax Number	:	561-748-1523

Provider Business Practice Location Address
First Line	:	2580 METROCENTRE BLVD
Second Line	:	SUITE 1
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3100
Country	:	US
Telephone Number	:	561-684-2022
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	04/28/2010

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Directions to “ DR. BEN THEBAUT M.D.” Practice Location

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