Provider Demographics
NPI:1316927866
Name:THIBODEAU, KRISTOPHER PAUL (M D)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:PAUL
Last Name:THIBODEAU
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 836 BOX 0036
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09636
Mailing Address - Country:US
Mailing Address - Phone:3909-556-4811
Mailing Address - Fax:3909-556-4822
Practice Address - Street 1:PSC 836 BOX 2370
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09636
Practice Address - Country:US
Practice Address - Phone:3909-556-4811
Practice Address - Fax:3909-556-4822
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine