Individual
DR. ADLY THEBAUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2725 REBECCA LN STE 107, ORANGE CITY, FL 32763-8350
(386) 775-0736
(386) 775-0738
Mailing address
2725 REBECCA LN STE 107, ORANGE CITY, FL 32763-8350
(386) 775-0736
(386) 775-0738
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME60436
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008922100
—
FL
01
—
12951
MEDICARE
FL
01
—
W9687
MEDICARE
FL
Enumeration date
01/27/2006
Last updated
04/06/2026
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