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General NPI Number Information
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NPI Number | 1225104235
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Entity Type | Individual
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Provider Name | MARK THIBERT MD
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 375 NW BEAVER ST STE 101
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City | PRINEVILLE
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State | OR
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Zip | 97754-1802
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Country | US
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Telephone | 541-383-3005
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Fax | 541-383-1883
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Provider Business Mailing Address
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Address Line | PO BOX 4228
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City | PORTLAND
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State | OR
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Zip | 97208-4228
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Country | US
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Telephone | 541-383-3005
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Fax | 541-383-1883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD169232
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5190415-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00048052
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD169232
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License Number State | OR
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