# DR. MARIO THELIARD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1669804720
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 020982 | PR | — |
| 208D00000X | General Practice Physician | ME140780 | FL | Yes |

## Other

- **Enumeration date:** 07/31/2013
- **Last updated:** 08/13/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 010726500 | — | FL |
| 01 | — | OS240 | MEDICARE | FL |