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1376579631
JUSTIN ROBERT THIBEAULT
PORTLAND, OR
NPI
1376579631
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: OR PA153476)
Enumeration Date
2006-06-25
Last Update Date
2016-07-06
Business Address
Mr. JUSTIN ROBERT THIBEAULT PA-C
1515 NW 18TH AVE 3RD FLOOR
PORTLAND, OR 97209-2516
Phone number: 503-224-8399
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Mailing Address
Mr. JUSTIN ROBERT THIBEAULT PA-C
200 NE MOTHER JOSEPH PL STE 210
VANCOUVER, WA 98664-3295
Phone number: 503-224-8399
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