Provider Demographics
NPI:1912973967
Name:THACKER, DIRK B (MD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:B
Last Name:THACKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:CENTRAL EMERGENCY PHYSICIANS PSC
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588
Mailing Address - Country:US
Mailing Address - Phone:859-277-8179
Mailing Address - Fax:859-277-9320
Practice Address - Street 1:1740 NICHOLASVILLE RD
Practice Address - Street 2:CENTRAL BAPTIST HOSPITAL EMERGENCY ROOM
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-260-6180
Practice Address - Fax:859-260-6693
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYKY37100207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64942071Medicaid
G80922Medicare UPIN
KY64942071Medicaid