Healthcare Provider Details

I. General information

NPI: 1003831447
Provider Name (Legal Business Name): BRIAN J. ACKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 ATLANTIC AVE SUITE 202
LONG BEACH CA
90806-1740
US

IV. Provider business mailing address

2865 ATLANTIC AVE SUITE 202
LONG BEACH CA
90806-1740
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-4444
  • Fax: 562-492-1157
Mailing address:
  • Phone: 562-595-4444
  • Fax: 562-492-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG35691
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG35691
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG35691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: