Provider Demographics
NPI:1710012448
Name:THIBODEAU, JENNIFER TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TAYLOR
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:UTSW MEDICAL CENTER, DIVISION OF CARDIOLOGY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9047
Mailing Address - Country:US
Mailing Address - Phone:214-645-7521
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:UTSW MEDICAL CENTER, DIVISION OF CARDIOLOGY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9047
Practice Address - Country:US
Practice Address - Phone:214-645-7521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64426207R00000X
TXN6713207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine