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General NPI Number Information
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NPI Number | 1093174377
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Entity Type | Organization
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Legal Business Name | ACKERMAN CANCER CENTER
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 1895 KINGSLEY AVE SUITE 903
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City | ORANGE PARK
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State | FL
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Zip | 32073-4466
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Country | US
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Telephone | 904-644-8353
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Fax | 904-644-8289
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Provider Business Mailing Address
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Address Line | 10881 SAN JOSE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32223-6612
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Country | US
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Telephone | 904-260-3022
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Fax | 904-260-3947
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SCOT ACKERMAN
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Credential | MD
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Telephone | 904-880-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME92864
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License Number State | FL
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