Individual
WAYNE THIBODEAUX
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3510 N CAUSEWAY BLVD, 404, METAIRIE, LA 70002-3531
(504) 779-5515
Mailing address
744 W MICHIGAN AVE, JACKSON, MI 49201-1909
(800) 242-1131
(517) 787-4146
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
023252
LA
Other
Enumeration date
05/18/2006
Last updated
07/08/2007
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