Provider Demographics
NPI:1134205164
Name:THAKKAR, DARSHAN B (MD)
Entity type:Individual
Prefix:DR
First Name:DARSHAN
Middle Name:B
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PARSONS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6066
Mailing Address - Country:US
Mailing Address - Phone:813-684-5255
Mailing Address - Fax:813-654-4486
Practice Address - Street 1:116 PARSONS PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6066
Practice Address - Country:US
Practice Address - Phone:813-684-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME969422086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
12578OtherUNIVERSAL
P00396697OtherR.R.MEDICARE
59050OtherBLUECROSS/BLUESHIELD
7569796OtherAETNA
8397192OtherCIGNA HMO
208871OtherAVMED
FL276490300Medicaid
P00396697OtherR.R.MEDICARE
59050OtherBLUECROSS/BLUESHIELD