Individual
MARK THIBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
375 NW BEAVER ST STE 101, PRINEVILLE, OR 97754-1802
(541) 383-3005
(541) 383-1883
Mailing address
PO BOX 4228, PORTLAND, OR 97208-4228
(541) 383-3005
(541) 383-1883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5190415-1205
UT
207Q00000X
Family Medicine Physician
MD00048052
WA
207Q00000X
Family Medicine Physician
MD169232
OR
207R00000X
Internal Medicine Physician
Primary
MD169232
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500678702
—
OR
Enumeration date
11/28/2006
Last updated
10/09/2024
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