Individual
DR. COLLEEN LYN THIBAUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1225 E GARRISON BLVD, GASTONIA, NC 28054-5115
(704) 865-7416
(704) 865-7232
Mailing address
1225 E GARRISON BLVD, GASTONIA, NC 28054-5115
(704) 865-7416
(704) 865-7232
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2015-01221
NC
207V00000X
Obstetrics & Gynecology Physician
5101019426
MI
Other
Enumeration date
06/07/2011
Last updated
08/26/2015
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