Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | T2392 | MS |
N | 111NI0900X | Internist | T2392 | MS |
Y | 207RI0011X | Interventional Cardiology | S4697 | TX |
NPI | 1073886875 |
---|---|
Provider Name | Dr. Andrew James Thibodeaux |
First Address | Brownwood, TX 76801-5952 |
Second Address | Brownwood, TX 76801-5952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2012 |
Last Update Date | 04/02/2021 |