Individual
DR. BRENT C THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11445 SUNSET HILLS RD, KAISER PERMANENTE RESTON MEDICAL CENTER, RESTON, VA 20190-5276
(703) 709-1500
(703) 709-1711
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101057696
VA
208000000X
Pediatrics Physician
D61216
MD
208000000X
Pediatrics Physician
MD034757
DC
Other
Enumeration date
12/12/2006
Last updated
06/23/2021
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