MEDICARE: DR. ANTHONY COLLINS THIBODEAUX M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	107454R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	990004179	OTHER	LA	PALMETTO GBA - RAILROAD M
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336147081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY COLLINS THIBODEAUX M.D.

Provider Business Mailing Address
First Line	:	4809 AMBASSADOR CAFFERY PKWY
Second Line	:	SUITE 200
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6917
Country	:	US
Telephone Number	:	337-981-6100
Fax Number	:	337-988-8751

Provider Business Practice Location Address
First Line	:	4630 AMBASSADOR CAFFERY PKWY
Second Line	:	STE 208
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6949
Country	:	US
Telephone Number	:	337-981-6100
Fax Number	:	337-988-8751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/14/2012

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