Thackeray, Jason W

Thackeray, Jason W is an individual health care provider with primary practice located at 1034 Mar Walt Dr Suite 100, Fort Walton Beach FL 32547-6645. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Thackeray, Jason W can be contacted via phone (850) 863-2153.

Contact Information

Primary practice address
1034 Mar Walt Dr Suite 100 Fort Walton Beach FL 32547-6645
Phone: (850) 863-2153
Fax: (850) 863-2885
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X ME77615 Florida

Profile Details

NPI number 1235133646
LBN Legal business name Thackeray, Jason W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2005
Last updated Oct 29th, 2020 - about 4 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 1235133646 NPPES
Florida MEDICAID 265809700

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