Clifford Lee Thacker
Family Doctor Obstetrician & Gynecologist Family Doctor - Addiction Medicine
12550 New Brittany Blvd Ste 201
Fort Myers
, Florida 33907
Clifford Lee Thacker
Family Doctor Obstetrician & Gynecologist Family Doctor - Addiction Medicine
12550 New Brittany Blvd Ste 201
Fort Myers
, Florida 33907
(239) 343-9193
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About
Features
Specialties
- Family Doctor
- Family Doctor - Addiction Medicine
- Obstetrician & Gynecologist
Languages spoken
- English
Location
First Address
- Clifford Lee Thacker
- Po Box 2147
- Fort Myers, FL
- Zip : 33902-2147
- Fax : (239) 343-9193
- Phone : (239) 343-9190
Second Address
- Clifford Lee Thacker
- 12550 New Brittany Blvd Ste 201
- Fort Myers, FL
- Zip : 33907
- Fax : (239) 343-9193
- Phone : (239) 343-9190
Reviews
FAQs
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In what state does Clifford Lee Thacker practice in?
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Is Clifford Lee Thacker a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207Q00000X | Family Doctor | ME70754 | FL |
| Y | 207QA0401X | Family Doctor - Addiction Medicine | ME70754 | FL |
| N | 207V00000X | Obstetrician & Gynecologist | ME0070754 | FL |
National Provider Identifier
| NPI | 1396731857 |
|---|---|
| Provider Name | Clifford Lee Thacker |
| First Address | Fort Myers, FL 33902-2147 |
| Second Address | Fort Myers, FL 33907 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/09/2005 |
| Last Update Date | 27/10/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 101588900 | (05) | FL |
| G28347 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.