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General NPI Number Information
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NPI Number | 1538342431
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Entity Type | Individual
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Provider Name | AMBROSE CARROLL THIBODEAUX JR. MT
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Gender | Male
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 1015 CHOCTAW DR
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City | OPELOUSAS
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State | LA
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Zip | 70570-6567
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Country | US
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Telephone | 337-934-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 CHOCTAW DR
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City | OPELOUSAS
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State | LA
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Zip | 70570-6567
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Country | US
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Telephone | 337-934-6453
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Fax |
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number | CLP.G02111-GEN
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License Number State | LA
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