Provider Demographics
NPI:1306844105
Name:MCKERNAN, PETER B (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:MCKERNAN
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Gender:M
Credentials:MD, DDS
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Mailing Address - Street 1:SELECT PHYSICIANS ALLIANCE
Mailing Address - Street 2:10002 PRINCESS PALM AVE. STE 332
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8327
Mailing Address - Country:US
Mailing Address - Phone:813-571-7184
Mailing Address - Fax:813-654-4695
Practice Address - Street 1:EAR NOST & THROAT ASSOCIATES
Practice Address - Street 2:6101 WEBB RD. STE 211
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2865
Practice Address - Country:US
Practice Address - Phone:813-884-4967
Practice Address - Fax:813-889-0847
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2019-05-03
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Provider Licenses
StateLicense IDTaxonomies
FLM.E. 0056480207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0621641Medicaid
FL09632YMedicare PIN