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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629049770 NPPES
Florida MEDICAID 008922100
Florida Other 12951

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