Individual
MR. KEITH M. THIBAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
275 W MACARTHUR, OAKLAND, CA 94611-5641
(510) 752-1000
Mailing address
275 W MACARTHUR, OAKLAND, CA 94611-5641
(510) 752-1000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5122
CA
Other
Enumeration date
12/13/2006
Last updated
11/14/2014
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