Healthcare Provider Details

I. General information

NPI: 1124656236
Provider Name (Legal Business Name): BRITTIN THIBODEAUX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 AMBASSADOR CAFFERY PKWY BLDG B
LAFAYETTE LA
70508-6902
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-984-1050
  • Fax: 337-984-8776
Mailing address:
  • Phone: 337-984-1050
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number341387
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: