Individual
IKE CLAYTON THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
L7215
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159116603
—
TX
05
—
159116604
—
TX
05
—
161586601
—
TX
Enumeration date
05/19/2006
Last updated
02/15/2012
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