Provider Demographics
NPI:1518045483
Name:THACKER, ANMONA (MD)
Entity Type:Individual
Prefix:
First Name:ANMONA
Middle Name:
Last Name:THACKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19722 SAUMS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4734
Mailing Address - Country:US
Mailing Address - Phone:281-600-0786
Mailing Address - Fax:281-600-7786
Practice Address - Street 1:19722 SAUMS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-4734
Practice Address - Country:US
Practice Address - Phone:281-600-0786
Practice Address - Fax:281-600-7786
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173000000X
DEC1-0009783208000000X
TXP7218208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2006-01358OtherSTATE LICENSE
DEC1-0009783OtherPROFESSIONAL LICENSE