CLIFFORD LEE THACKER (NPI# 1396731857) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396731857 |
| Entity Type | Individual |
| Full Name | CLIFFORD LEE THACKER |
| Credential | MD |
| Practice Address |
12550 New Brittany Blvd Ste 201 Fort Myers FL 33907 |
| Mailing Address |
Po Box 2147 Fort Myers FL 33902-2147 |
| Practice Telephone | 2393439190 |
| Practice Fax Number | 2393439193 |
| Mailing Telephone | 2393439190 |
| Mailing Fax Number | 2393439193 |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2020-10-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | ME70754 | FL | Allopathic & Osteopathic Physicians |
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
ME70754 | FL | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | ME0070754 | FL | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
ME70754 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 101588900 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9818 Old Hyde Park Pl, Bradenton, FL 342024091 | (941) 556-9337 | |
| 12550 New Brittany Blvd Ste 201, Fort Myers, FL 33907 | 2393439190 | 2393439193 |
| Street Address |
12550 NEW BRITTANY BLVD STE 201 |
| City | FORT MYERS |
| State | FL |
| Zip Code | 33907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942826623 | Lee Memorial Health System | Clinic/Center | 12550 New Brittany Blvd Ste 201, Fort Myers, FL 33907-3655 | 2020-06-18 |
| 1316979214 | Stephen P Moenning | Family Medicine | 12550 New Brittany Blvd Ste 201, Fort Myers, FL 33907 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134739253 | Islande Dorcin | Social Worker | 13300 South Cleveland Ave Suite 56 # 822, Fort Myers, FL 33907 | 2020-08-04 |
| 1003462268 | Ronny Rodolfo Herrera | Behavior Technician | Beacon Executive Suites, 8359 Beacon Blvd, Suite#416, Homestead, FL 33907 | 2019-08-14 |
| 1528549094 | Deborah Senese Streater | Dentist | 12530 New Brittany Blvd., Fort Myers, FL 33907 | 2018-08-23 |
| 1437648391 | Rita Lusinete Rabitt | Registered Nurse | 14084 Clear Water Ln, Fort Myers, FL 33907 | 2018-05-07 |
| 1972092146 | Surgery Centre of Sw Florida LLC | Clinic/Center | 13051 University Dr Ste 102, Fort Myers, FL 33907 | 2018-05-03 |
| 1740787761 | Care Transport Inc | Non-emergency Medical Transport (VAN) | 7850 Reflection Cove Dr, Fort Myers, FL 33907 | 2018-04-06 |
| 1942730692 | Concierge Care of Fort Myers, LLC | In Home Supportive Care | 12253 New Brittany Boulevard, Suite 32, Fort Myers, FL 33907 | 2017-06-15 |
| 1710411467 | Johnnie Terrell | Social Worker | 43 Barkley Cir #102, Fort Myers, FL 33907 | 2017-04-19 |
| 1881041184 | Hchs Medical Center | Clinic/Center | 35 Barkley Circle, Unit 2, Fort Myers, FL 33907 | 2016-05-17 |
| 1043665227 | Tong Liu | Dentist | 8016 Summerlin Lakes Dr, Fort Myers, FL 33907 | 2016-04-26 |
| Find all providers in zip 33907 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316979214 | Stephen P Moenning | Family Medicine | 12550 New Brittany Blvd Ste 201, Fort Myers, FL 33907 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649895095 | Bdmj Holdings | Family Medicine | 2150 Lake Ida Rd Ste 2, Delray Beach, FL 33445-2443 | 2020-06-11 |
| 1932730942 | Freeport Medical Associates | Family Medicine | 17256 Main St N Ste 1, Blountstown, FL 32424-1775 | 2020-01-29 |
| 1649822867 | Medical Partners of The Palm Beaches | Family Medicine | 2600 Quantum Blvd Bldg A, Boynton Beach, FL 33426-8627 | 2019-07-09 |
| 1780247064 | Pinnacle Rehabilitation Group | Family Medicine | 1680 Se Lyngate Dr Ste 204, Port Saint Lucie, FL 34952-4300 | 2019-04-22 |
| 1518441252 | Solstice Health and Wellness, LLC | Family Medicine | 1219 S East Ave South, Suite C204, Sarasota, FL 34239-2340 | 2018-09-19 |
| 1063956761 | Inspirations Recovery Center, LLC | Family Medicine | 5208 10th Ave N, Greenacres, FL 33463-2053 | 2016-12-14 |
| 1003365800 | Family First | Family Medicine | 5220 Hood Road, Suite 100, Palm Beach Gardens, FL 33418-8910 | 2016-09-22 |
| 1396290409 | Aquarius Physicians Group | Family Medicine | 749 Us Highway 1, Suite 210, North Palm Beach, FL 33408-4400 | 2016-08-18 |
| 1861823452 | Parthenon Behavioral Center | Family Medicine | 5101 Bowden Road, Jacksonville, FL 32216 | 2013-12-06 |
| 1457697278 | South Walton Medical Group | Family Medicine | 10065 Us Highway 98 W Ste B101, Miramar Beach, FL 32550-1902 | 2012-12-26 |
| Find all providers with the same taxonomy | ||||
| City | FORT MYERS |
| Zip Code | 33907 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.