NPI 1003119744

Jon-Marc Thibodeau, PAC

Practitioner Physician Assistant Fort Leonard Wood, MO

Practice location

Address: 4430 Missouri Ave, Fort Leonard Wood, MO 65473-9098
Phone: (573) 596-0035
Mailing address: 4430 Missouri Ave # 1267, Fort Leonard Wood, MO 65473-9098

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 1095643

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Registry record

NPI: 1003119744
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 Dec 2010
Record last updated: 16 Feb 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.