Organization
JASON W THACKERAY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON W THACKERAY M.D. (PHYSICIAN)
(850) 863-2153
Entity
Organization
Contact information
Practice address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 315-9350
Mailing address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 315-9350
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
ME77615
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568504173
RAILROAD MEDICARE
FL
01
—
17147
BS PROVIDER NUMBER
FL
05
—
265809700
—
FL
Enumeration date
02/12/2007
Last updated
10/29/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us