Individual
JEANNE DAUPHINE THERIOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
112 CHAMPAGNE BLVD, BREAUX BRIDGE, LA 70517-3852
(337) 332-2242
(337) 332-4074
Mailing address
112 CHAMPAGNE BLVD, BREAUX BRIDGE, LA 70517-3852
(337) 332-2242
(337) 332-4074
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200073
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1062472
—
LA
Enumeration date
05/05/2006
Last updated
02/12/2014
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