Individual
CARYN THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3926 NEW VISION DR, FORT WAYNE, IN 46845-1712
(419) 445-2015
(419) 445-8102
Mailing address
442 W HIGH ST, BRYAN, OH 43506-1681
(419) 636-4517
(419) 636-6438
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-082516
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2432264
—
OH
01
—
P00245754
RAILROAD
OH
Enumeration date
06/21/2006
Last updated
01/12/2017
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