Thacker, Richard Randall

Thacker, Richard Randall is an individual health care provider with primary practice located at 2770 Capital Medical Blvd Ste 200, Tallahassee FL 32308-8417. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Thacker, Richard Randall can be contacted via phone (850) 878-8235.

Contact Information

Primary practice address
2770 Capital Medical Blvd Ste 200 Tallahassee FL 32308-8417
Phone: (850) 878-8235
Fax: (850) 219-2373
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MEOS6976 Florida

Profile Details

NPI number 1114920261
LBN Legal business name Thacker, Richard Randall
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2005
Last updated Aug 20th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114920261 NPPES
Florida Other 058464900 MEDICAID GROUP
Florida Other 57188 MEDICAID GROUP
Florida Other 99039 MEDICAID GROUP
Florida MEDICAID 37822101 MEDICAID GROUP
Florida Other P00625814 MEDICAID GROUP
Florida MEDICAID 1114920261 MEDICAID GROUP

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