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:
Health care specialties
Specialty | Code | License # | 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 2 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1396731857 | NPPES |
Florida | MEDICAID | 101588900 |
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