Provider Demographics
NPI:1578679098
Name:ACKERMAN, PETER JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JONATHAN
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 1:2402 E. M.L. KING JR. BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-866-0929
Practice Address - Street 1:1229 E 131ST AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3619
Practice Address - Country:US
Practice Address - Phone:813-866-0950
Practice Address - Fax:813-866-0929
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-96422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine