Individual
MR. JUSTIN ROBERT THIBEAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1515 NW 18TH AVE, 3RD FLOOR, PORTLAND, OR 97209-2516
(503) 224-8399
(503) 224-5661
Mailing address
200 NE MOTHER JOSEPH PL, STE 210, VANCOUVER, WA 98664-3295
(503) 224-8399
(503) 224-5661
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA153476
OR
Other
Enumeration date
06/25/2006
Last updated
07/06/2016
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