Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | ME20057 | FL |
NPI | 1255352787 |
---|---|
Provider Name | Dr. Ben Thebaut |
First Address | Jupiter, FL 33468-0011 |
Second Address | West Palm Beach, FL 33407-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 28/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D62688 | (02) |