Individual
THIMOTEE ILBOUDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3198 HIGHWAY 412 STE B, COLCORD, OK 74338-1356
(479) 365-7096
Mailing address
3198 HIGHWAY 412 STE B206, COLCORD, OK 74338-1356
(479) 365-7096
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
—
AR
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
05/31/2016
Last updated
07/04/2022
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