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General NPI Number Information
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NPI Number | 1548572985
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Entity Type | Organization
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Legal Business Name | JOHN B. THEOBALDS & ASSOCIATE INC
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 3636 16TH ST NW SUITE AG69
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City | WASHINGTON
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State | DC
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Zip | 20010-1146
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Country | US
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Telephone | 202-667-8701
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Fax | 202-234-9218
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Provider Business Mailing Address
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Address Line | 3636 16TH ST NW SUITE AG69
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City | WASHINGTON
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State | DC
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Zip | 20010-1146
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Country | US
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Telephone | 202-667-8701
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Fax | 202-234-9218
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN B THEOBALDS
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Credential | M.D.
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Telephone | 202-667-8701
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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 | MD11684
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License Number State | DC
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