Provider Demographics
NPI:1366684615
Name:ACKERMAN, BRIAN EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EVAN
Last Name:ACKERMAN
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 1:1560 GULF BLVD
Mailing Address - Street 2:UNIT 503
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2900
Mailing Address - Country:US
Mailing Address - Phone:842-642-7114
Mailing Address - Fax:
Practice Address - Street 1:6500 38TH AVE N
Practice Address - Street 2:ST. PETERSBURG GENERAL HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1629
Practice Address - Country:US
Practice Address - Phone:727-384-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113358207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine