Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jason W Thackeray MD PA

Organization Sports Medicine (Orthopaedic Surgery) Physician · NPI 1568504173

Jason W Thackeray MD PA is a Sports Medicine (Orthopaedic Surgery) Physician in Fort Walton Beach, Florida. Licensed in Florida. Registered with an NPI since 2007.

Licensed in
FL
In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1034 Mar Walt Dr Ste 100
Fort Walton Beach, FL 32547-6645
Phone: (850) 863-2153
Fax: (850) 315-9350
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Orthopaedic Surgery) Physician (primary) Taxonomy 207XX0005X · Licence ME77615 (FL)

Record details

NPI number1568504173
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jason Thackeray — Physician · (850) 863-2153
NPI enumeratedFebruary 12, 2007
Last updated in NPPESOctober 29, 2020
Certification dateOctober 29, 2020
Mailing address1034 Mar Walt Dr Ste 100, Fort Walton Beach, FL 32547-6645

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