Individual
DR. JONATHAN DAVID THACKERAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 CHILDRENS PLZ, DAYTON, OH 45404-1815
(937) 641-4000
(937) 641-3918
Mailing address
PO BOX 933432, CLEVELAND, OH 44193-0039
(937) 641-3000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35.083628
OH
2080C0008X
Child Abuse Pediatrics Physician
Primary
35.083628
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2545026
—
OH
Enumeration date
08/10/2005
Last updated
10/12/2023
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