Healthcare Provider Details

I. General information

NPI: 1942356621
Provider Name (Legal Business Name): RONALD T ACKERMAN SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 VILLAGE BLVD SUITE 201
WEST PALM BEACH FL
33409
US

IV. Provider business mailing address

603 VILLAGE BLVD SUITE 201
WEST PALM BEACH FL
33409
US

V. Phone/Fax

Practice location:
  • Phone: 561-683-1331
  • Fax: 561-683-4615
Mailing address:
  • Phone: 561-683-1331
  • Fax: 561-683-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0043294
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: