Individual
BRYAN C THIBODEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12221 MERIT DR, SUITE 1610, DALLAS, TX 75251-2202
(214) 217-1912
Mailing address
12221 MERIT DR, SUITE 1610, DALLAS, TX 75251-2202
(214) 217-1912
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
N2840
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203457101
—
TX
01
—
8CA552
BCBS
TX
01
—
P00814340
RAILROAD
TX
Enumeration date
03/10/2007
Last updated
05/27/2010
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