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CLIFFORD LEE THACKER MD
NPI 1396731857
Family Medicine - Addiction Medicine in Fort Myers, FL

Active since September 21, 2005
12550 NEW BRITTANY BLVD STE 201, FORT MYERS, FL 33907(239) 343-9190(239) 343-9193 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jul 21, 2022, Oct 27, 2020, Nov 6, 2019 and 4 more (7 updates tracked since 2017).

About Clifford Lee Thacker Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLIFFORD LEE THACKER MD (NPI 1396731857) is an individual addiction medicine provider in Fort Myers, Florida, licensed in Florida (ME70754) and active in the NPI registry since September 2005. He maintains 2 additional practice locations.

NPPES Registry Identity

NPI1396731857
Entity TypeIndividualMale
Primary Taxonomy207QA0401X
Provider Legal NameCLIFFORD LEE THACKERCredential: MD
Location Address12550 NEW BRITTANY BLVD STE 201Fort Myers, FL 33907
Mailing AddressPo Box 2147Fort Myers, FL 33902-2147 · (239) 343-9190 · Fax (239) 343-9193
Phone(239) 343-9190
Fax(239) 343-9193
Sole ProprietorNo
Enumeration DateSeptember 21, 2005
Last NPPES UpdateJuly 21, 20227 updates tracked since enumeration
NPPES CertifiedOctober 27, 2020
✔ NPI 1396731857 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyFamily Medicine · Addiction MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0401X
License✔ Licensed in FL · ME70754
Definition
A family medicine physician who specializes in the diagnosis and treatment of addictions.
Also ListedFamily MedicineTaxonomy 207Q00000X · License ME70754 (FL)
Also ListedObstetrics & GynecologyTaxonomy 207V00000X · License ME0070754 (FL)
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License ME70754 (FL)
12550 NEW BRITTANY BLVD STE 201, Fort Myers, FL 33907
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Secondary Practice Locations 2

Location 19818 Old Hyde Park PlBradenton, FL 34202-4091 · Phone (941) 556-9337
Location 212550 New Brittany Blvd Ste 201Fort Myers, FL 33907 · Phone (239) 343-9190 · Fax (239) 343-9193

Other Identifiers 1

Medicaid101588900FL

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERT S LIMBAUGH III M.D.
Internal Medicine (Addiction Medicine)
12550 NEW BRITTANY BLVD STE 201
FORT MYERS, FL 33907
Lee County (239) 343-9190
DERICK ALLEN DUSTON LMHC
Counselor (Mental Health)
12550 NEW BRITTANY BLVD STE 201
FORT MYERS, FL 33907
Lee County (239) 343-9180
LEE MEMORIAL HEALTH SYSTEM
Clinic/Center (Federally Qualified Health Center (FQHC))
12550 NEW BRITTANY BLVD STE 201
FORT MYERS, FL 33907
Lee County (239) 343-9190

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clifford Thacker's NPI number?

The NPI number for Clifford Thacker is 1396731857. It was assigned to this individual provider in the NPPES registry on September 21, 2005.

Where is Clifford Thacker located?

Clifford Thacker practices at 12550 New Brittany Blvd Ste 201, Fort Myers, FL 33907. The listed phone number is (239) 343-9190.

What is Clifford Thacker's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Addiction Medicine, with taxonomy code 207QA0401X.

When was this NPI record last updated?

The NPPES record for Clifford Thacker was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.