Thacker, Clifford Lee

Thacker, Clifford Lee is an individual health care provider with primary practice located at 12550 New Brittany Blvd Ste 201 , Fort Myers FL 33907. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Addiction Medicine is his primary health care specialty. Thacker, Clifford Lee can be contacted via phone (239) 343-9190.

Contact Information

Primary practice address
12550 New Brittany Blvd Ste 201 Fort Myers FL 33907
Phone: (239) 343-9190
Fax: (239) 343-9193
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME70754 Florida
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X ME0070754 Florida
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X ME70754 Florida
Allopathic & Osteopathic Physicians / Addiction Medicine 207QA0401X ME70754 Florida

Profile Details

NPI number 1396731857
LBN Legal business name Thacker, Clifford Lee
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2005
Last updated Jul 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396731857 NPPES
Florida MEDICAID 101588900

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