Individual
TIMOTHY JOHN QUEBEDEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7777 HENNESSY BLVD, BATON ROUGE, LA 70808-4300
(225) 765-1763
Mailing address
DEPT AT952639, ATLANTA, GA 31192-2639
(888) 447-2450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200195
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1451703
—
LA
Enumeration date
03/05/2009
Last updated
05/04/2009
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