Provider Demographics
NPI:1861557878
Name:THIBAULT, FRANK G (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:G
Last Name:THIBAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3327
Mailing Address - Country:US
Mailing Address - Phone:501-315-7774
Mailing Address - Fax:501-315-7772
Practice Address - Street 1:910 N EAST ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3327
Practice Address - Country:US
Practice Address - Phone:501-315-7774
Practice Address - Fax:501-315-7772
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4061207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105455001Medicaid
ARB90617Medicare UPIN
AR105455001Medicaid