Individual
DR. JASON W THACKERAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1034 MAR WALT DR, SUITE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 863-2885
Mailing address
1034 MAR WALT DR, SUITE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 863-2885
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME77615
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265809700
—
FL
Enumeration date
06/13/2005
Last updated
10/29/2020
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