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Individual
DR. RICHARD RANDALL THACKER
Active
Individual
DR. RICHARD RANDALL THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MEOS6976
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058464900
MEDICAID GROUP
FL
05
—
1114920261
—
GA
05
—
37822101
—
FL
01
—
57188
INDIVIDUAL PROVIDER BCBS
FL
01
—
99039
GROUP BCBS ID NUMBER
FL
01
—
P00625814
MEDICARE RAILROAD
FL
Enumeration date
05/23/2005
Last updated
08/20/2016
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