Individual
JOEL D THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 OAK PARK BLVD, LAKE CHARLES, LA 70601-8911
(337) 494-3190
Mailing address
PO BOX 3780, TUPELO, MS 38803-3780
(318) 841-9526
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
025001
LA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
N3344
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1423602
—
LA
01
—
1972698918
INDIVIDUAL NPI NUMBER
—
Enumeration date
10/04/2006
Last updated
04/03/2019
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