Healthcare Provider Details

I. General information

NPI: 1578679098
Provider Name (Legal Business Name): PETER JONATHAN ACKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 E 131ST AVE
TAMPA FL
33612-3619
US

IV. Provider business mailing address

2402 E. M.L. KING JR. BLVD
TAMPA FL
33610
US

V. Phone/Fax

Practice location:
  • Phone: 813-866-0950
  • Fax: 813-866-0929
Mailing address:
  • Phone: 813-866-0930
  • Fax: 813-866-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME-96422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: