Provider Demographics
NPI:1003831447
Name:ACKER, BRIAN J (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:ACKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 ATLANTIC AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1740
Mailing Address - Country:US
Mailing Address - Phone:562-595-4444
Mailing Address - Fax:562-492-1157
Practice Address - Street 1:2865 ATLANTIC AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1740
Practice Address - Country:US
Practice Address - Phone:562-595-4444
Practice Address - Fax:562-492-1157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35691208600000X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G356910Medicaid
CAA46441Medicare UPIN
CAG35691Medicare ID - Type Unspecified