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NPI Code Detail

MEDICARE: DR. ADLY THEBAUD MD

MEDICARE: DR. ADLY THEBAUD MD
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
12084P0800XPsychiatry PhysicianME60436FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112951OTHERFLMEDICARE
2W9687OTHERFLMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629049770
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADLY THEBAUD MD
Provider Business Mailing Address
First Line : 2725 REBECCA LN STE 107
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-8350
Country : US
Telephone Number : 386-775-0736
Fax Number : 386-775-0738
Provider Business Practice Location Address
First Line : 2725 REBECCA LN STE 107
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-8350
Country : US
Telephone Number : 386-775-0736
Fax Number : 386-775-0738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 04/06/2026

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Directions to “ DR. ADLY THEBAUD MD” Practice Location

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