Thebaud, Adly
Thebaud, Adly is an sole proprietor health care provider with primary practice located at 2725 Rebecca Ln Ste 107 , Orange City FL 32763-8350. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Thebaud, Adly can be contacted via phone (386) 775-0736.Contact Information
Primary practice address
2725 Rebecca Ln Ste 107
Orange City FL 32763-8350
Phone: (386) 775-0736
Fax: (386) 775-0738
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | ME60436 | Florida |
Profile Details
| NPI number | 1629049770 |
|---|---|
| LBN Legal business name | Thebaud, Adly |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 27th, 2006 |
| Last updated | Nov 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629049770 | NPPES |
| Florida | MEDICAID | 008922100 | |
| Florida | Other | 12951 |
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