Individual
DONNA M THIBODEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2100 N DR MARTIN LUTHER KING JR BLVD, CLOVIS PLAINS REG MED CTR, CLOVIS, NM 88101-9412
(505) 769-2141
(505) 769-7337
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
86135
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37507
—
NM
Enumeration date
03/05/2007
Last updated
03/18/2009
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