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General NPI Number Information
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NPI Number | 1447693619
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Entity Type | Individual
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Provider Name | ROSS J THIBODAUX M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 726 N ACADIA RD STE 3400
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City | THIBODAUX
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State | LA
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Zip | 70301
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Country | US
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Telephone | 985-449-4656
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Fax | 985-449-2532
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Provider Business Mailing Address
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Address Line | 726 N ACADIA RD STE 3400
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City | THIBODAUX
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State | LA
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Zip | 70301-5011
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Country | US
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Telephone | 985-449-4656
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Fax | 985-449-2532
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD.207890
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License Number State | LA
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