Individual
MAXINE A THERIOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3098 OAK GROVE RD, POPLAR BLUFF, MO 63901-8938
(573) 686-8199
(573) 686-8398
Mailing address
709 W RUSK ST STE B, ROCKWALL, TX 75087-3600
(972) 786-0140
(972) 786-0142
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
J9578
TX
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
2022047286
MO
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
J9578
TX
Other
Enumeration date
01/10/2007
Last updated
07/13/2023
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