Individual
MR. ALLEN J THIBODEAUX JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2606 HOSPITAL BLVD, CORPUS CHRISTI, TX 78405-1804
(361) 455-5358
Mailing address
7502 BRIECESCO, CORPUS CHRISTI, TX 78414-6164
(361) 455-5358
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
699595
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85524U
BCBSTX
TX
Enumeration date
11/16/2005
Last updated
08/01/2011
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