Individual
MR. AMBROSE CARROLL THIBODEAUX JR.
Active
Individual
MR. AMBROSE CARROLL THIBODEAUX JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
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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