Individual
MR. AMBROSE CARROLL THIBODEAUX JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
1015 CHOCTAW DR, OPELOUSAS, LA 70570-6567
(337) 934-6453
Mailing address
1015 CHOCTAW DR, OPELOUSAS, LA 70570-6567
(337) 934-6453
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
CLP.G02111-GEN
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1499
BRD CLIN LAB SCIEN PRACT
MT
01
—
19554TCL-0
BUR OF LIC & CERT.
NE
01
—
CLP.G02111-GEN
ST BRD MEDICAL EXAMINES
LA
Enumeration date
12/13/2007
Last updated
12/13/2007
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