Individual provider · Type 1 NPI

Justin Robert Thibeault, PA-C

Surgical Physician Assistant · Portland, OR

NPI number 1376579631 Active

Practice location

1515 NW 18th Ave, 3rd Floor
Portland, OR 97209-2516

Call (503) 224-8399 Map

Fax (503) 224-5661

Mailing address

200 NE Mother Joseph Pl, Ste 210
Vancouver, WA 98664-3295

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400XPA153476 (OR)

Surgical Physician Assistant: Definition to come...

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About NPI 1376579631

Justin Robert Thibeault, PA-C's National Provider Identifier is 1376579631, issued on Jun 25, 2006. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Portland, OR. The record was last updated on Jul 6, 2016.