Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Maxine A Theriot, MD

Individual provider Family Medicine Physician · NPI 1194874628

Maxine A Theriot, MD is a Family Practice in Poplar Bluff, Missouri. Graduated from Loma Linda University School of Medicine in 1994, 32 years ago. Practices with Poplar Bluff Hma Physician Management, LLC, a 41-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Missouri and Texas.

Years since qualifying
32
Trained at
Loma Linda University School of Medicine
Licensed in
MO, TX
In the registry since
2007
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3098 Oak Grove Rd
Poplar Bluff, MO 63901-8938
Phone: (573) 686-8199
Fax: (573) 686-8398
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1650 W College St, Grapevine, TX 76051-3565 — (972) 816-0459

Specialties & licences

Undersea and Hyperbaric Medicine (Preventive Medicine) Physician (primary) Taxonomy 2083P0011X · Licence 2022047286 (MO)
Family Medicine Physician Taxonomy 207Q00000X · Licence J9578 (TX)
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician Taxonomy 2083P0011X · Licence J9578 (TX)

Record details

NPI number1194874628
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJanuary 10, 2007
Last updated in NPPESJuly 13, 2023
Certification dateJuly 13, 2023
Mailing address709 W Rusk St Ste B, Rockwall, TX 75087-3600

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Also practisesUNDERSEA AND HYPERBARIC MEDICINE
Medical schoolLOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Graduated 1994 (32 years in practice)
Group practice Poplar Bluff Hma Physician Management, Llc — 41 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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