Healthcare Provider Details

I. General information

NPI: 1023233012
Provider Name (Legal Business Name): FRANK G THIBAULT MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N EAST ST
BENTON AR
72015-3327
US

IV. Provider business mailing address

910 N EAST ST
BENTON AR
72015-3327
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-7774
  • Fax: 501-315-7772
Mailing address:
  • Phone: 501-315-7774
  • Fax: 501-315-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateAR

VIII. Authorized Official

Name: FRANK G THIBAULT
Title or Position: OWNER
Credential: MD
Phone: 501-315-7774