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NPI Code Detail

MEDICARE: DR. TODD ALAN THACKER DO

MEDICARE: DR. TODD ALAN THACKER DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianDOS-1710HI
2207Q00000XFamily Medicine PhysicianJ9383TX

General Provider Information

NPI Number : 1528031747
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TODD ALAN THACKER DO
Provider Business Mailing Address
First Line : 1705 E 11TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78702-2709
Country : US
Telephone Number : 512-978-8400
Fax Number :
Provider Business Practice Location Address
First Line : 1705 E 11TH ST
Second Line :
City : AUSTIN
State : TX
Zip : 78702-2709
Country : US
Telephone Number : 512-978-8400
Fax Number : 512-901-9785
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 02/12/2018

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Directions to “ DR. TODD ALAN THACKER DO” Practice Location

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