Individual
DR. TERRY BRANDON THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3700 WASHINGTON AVE, ANESTHESIA DEPARTMENT, EVANSVILLE, IN 47714-0541
(812) 473-0181
(812) 473-5822
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01074781A
IN
207L00000X
Anesthesiology Physician
46195
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000915791
ANTHEM BCBS
IN
05
—
201196380
—
IN
05
—
7100253180
—
KY
01
—
P01426525
RAILROAD MEDICARE
—
Enumeration date
04/18/2009
Last updated
02/03/2016
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