Individual
DR. JEREMY WAYNE THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 ROSE ST, HX-302 UKMC, LEXINGTON, KY 40536-0293
(859) 257-4457
Mailing address
800 ROSE ST, HX316, LEXINGTON, KY 40536-0293
(859) 948-7773
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
41747
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100097180
—
KY
Enumeration date
05/23/2007
Last updated
08/06/2015
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