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JASON W THACKERAY MD PA
NPI 1568504173
Orthopaedic Surgery - Sports Medicine in Fort Walton Beach, FL

Active since February 12, 2007
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547(850) 863-2153(850) 315-9350 Get Directions Write a Review

NPPES record last updated: October 29, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jason W Thackeray Md Pa NPPES

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

JASON W THACKERAY MD PA (NPI 1568504173) is a healthcare organization registered as a sports medicine in Fort Walton Beach, Florida and active in the NPI registry since February 2007. The organization lists Jason W Thackeray, Physician, as its authorized official.

NPPES Registry Identity

NPI1568504173
Entity TypeOrganization
Primary Taxonomy207XX0005X
Legal Business NameJASON W THACKERAY MD PA
Location Address1034 MAR WALT DR STE 100Fort Walton Beach, FL 32547-6645
Mailing Address1034 Mar Walt Dr Ste 100Fort Walton Beach, FL 32547-6645 · (850) 863-2153 · Fax (850) 315-9350
Phone(850) 863-2153
Fax(850) 315-9350
Organization SubpartNo
Authorized OfficialJason W ThackerayPhysician · (850) 863-2153
Enumeration DateFebruary 12, 2007
Last NPPES UpdateOctober 29, 2020
NPPES CertifiedOctober 29, 2020
✔ NPI 1568504173 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207XX0005X
License✔ Licensed in FL · ME77615
Definition
An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.
1034 MAR WALT DR STE 100, Fort Walton Beach, FL 32547
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Other Identifiers 3

Other1568504173FL · Railroad Medicare
Medicaid265809700FL
Other17147FL · Bs Provider Number

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 9

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

DR. WILLIAM R MARSHALL MD PA
Orthopaedic Surgery
1034 MAR WALT DR STE 100
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 863-2153
THEODORE I MACEY MD PA
Orthopaedic Surgery (Sports Medicine)
1034 MAR WALT DR STE 100
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 863-2153
MARK J TENHOLDER MD PA
Orthopaedic Surgery (Sports Medicine)
1034 MAR WALT DR STE 100
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 863-2153
WILLIAM R MARSHALL MD PA
Orthopaedic Surgery (Sports Medicine)
1034 MAR WALT DR STE 100
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 863-2153
DR. MARK J TENHOLDER MD PA
Orthopaedic Surgery
1034 MAR WALT DR STE 100
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 863-2153
JOSEPH R AGOSTINELLI DPM PA
Podiatrist (Foot & Ankle Surgery)
1034 MAR WALT DR STE 100
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 863-2153
JOHN C WARBURTON MD PA
Orthopaedic Surgery
1034 MAR WALT DR STE 100
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 863-2153
DR. JOSEPH R AGOSTINELLI DPM PA
Podiatrist
1034 MAR WALT DR STE 100
FORT WALTON BEACH, FL 32547
Okaloosa County (850) 863-2153

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 Jason W Thackeray MD PA's NPI number?

The NPI number for Jason W Thackeray MD PA is 1568504173. It was assigned to this organization in the NPPES registry on February 12, 2007.

Where is Jason W Thackeray MD PA located?

Jason W Thackeray MD PA is located at 1034 Mar Walt Dr Ste 100, Fort Walton Beach, FL 32547. The listed phone number is (850) 863-2153.

What is Jason W Thackeray MD PA's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Sports Medicine, with taxonomy code 207XX0005X.

When was this NPI record last updated?

The NPPES record for Jason W Thackeray MD PA was last updated on October 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.