IndividualActive
Maxine Theriot, MD
NPI 1194874628 · Undersea and Hyperbaric Medicine (Preventive Medicine) Physician · Poplar Bluff, MO
Provider details
- NPI number
- 1194874628
- Entity type
- Individual
- Primary specialty
- Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- License
- J9578 (TX)
Practice location
3098 Oak Grove Rd
Poplar Bluff, MO 63901-8938
Phone: (573) 686-8199
Fax: (573) 686-8398
Mailing address
709 W Rusk St Ste B
Rockwall, TX 75087-3600
Registry dates
- Enumerated
- 2007-01-10
- Last updated
- 2023-07-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.