CLIFFORD LEE THACKER MD NPI 1396731857

NPI Information

NPI: 1396731857
Provider Name: CLIFFORD LEE THACKER, MD
Classification: Family Medicine - 207QA0401X
Entity Type: Individual

Specialization: Addiction Medicine

Address:
12550 NEW BRITTANY BLVD STE 201
FORT MYERS, FL
ZIP 33907
Phone: (239) 343-9190
Get Directions

Clifford Lee Thacker, MD is an addiction medicine family medicine in Fort Myers, FL. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. Clifford Lee Thacker, MD NPI is 1396731857. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

12550 NEW BRITTANY BLVD STE 201
FORT MYERS, FL
ZIP 33907
Phone: (239) 343-9190
Fax: (239) 343-9193

The enumeration date for this NPI number is 9/21/2005 and was last updated on 10/27/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		ME70754	FLORIDA	No
2	207QA0401X	Family Medicine	Addiction Medicine	ME70754	FLORIDA	Yes
3	207V00000X	Obstetrics & Gynecology		ME0070754	FLORIDA	No
4	2084P0800X	Psychiatry & Neurology	Psychiatry	ME70754	FLORIDA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	101588900	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »