MEDICARE: DR. PETER B MCKERNAN MD, DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	M.E. 0056480	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306844105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER B MCKERNAN MD, DDS

Provider Business Mailing Address
First Line	:	SELECT PHYSICIANS ALLIANCE
Second Line	:	10002 PRINCESS PALM AVE. STE 332
City	:	TAMPA
State	:	FL
Zip	:	33619-8327
Country	:	US
Telephone Number	:	813-571-7184
Fax Number	:	813-654-4695

Provider Business Practice Location Address
First Line	:	EAR NOST & THROAT ASSOCIATES
Second Line	:	6101 WEBB RD. STE 211
City	:	TAMPA
State	:	FL
Zip	:	33615-2865
Country	:	US
Telephone Number	:	813-884-4967
Fax Number	:	813-889-0847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	05/03/2019

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