Individual
CHRISTOPHER THIBEAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10326 S OSWEGO AVE, TULSA, OK 74137
(918) 863-3789
Mailing address
10326 S OSWEGO AVE, TULSA, OK 74137
(918) 863-3789
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1205487493
OK
Other
Enumeration date
09/27/2019
Last updated
01/15/2020
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