Provider Demographics
NPI:1093804759
Name:THIBODEAUX, DOUGLAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:THIBODEAUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5353
Mailing Address - Country:US
Mailing Address - Phone:281-342-0222
Mailing Address - Fax:281-238-0009
Practice Address - Street 1:1601 MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3247
Practice Address - Country:US
Practice Address - Phone:281-342-0222
Practice Address - Fax:281-238-0009
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7142207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8798K7Medicare ID - Type Unspecified
TXB26954Medicare UPIN