Individual
MR. BARRY LYNN THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1463 SE LOOP 456, JACKSONVILLE, TX 75766-9184
(903) 589-1150
Mailing address
1463 SE LOOP 456, JACKSONVILLE, TX 75766-9184
(903) 589-1150
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
590631
TX
Other
Enumeration date
08/12/2006
Last updated
07/08/2007
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