Provider Demographics
NPI:1447693619
Name:THIBODAUX, ROSS J (MD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:J
Last Name:THIBODAUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:726 N ACADIA RD STE 3400
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5011
Mailing Address - Country:US
Mailing Address - Phone:985-449-4656
Mailing Address - Fax:985-449-2532
Practice Address - Street 1:726 N ACADIA RD STE 3400
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-449-4656
Practice Address - Fax:985-449-2532
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.207890207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2332324Medicaid