Provider Demographics
NPI:1710970322
Name:ACKERMAN, GARY N (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:N
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 1:4440 BEACON CIR
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3243
Mailing Address - Country:US
Mailing Address - Phone:561-845-6000
Mailing Address - Fax:561-845-6916
Practice Address - Street 1:4440 BEACON CIR
Practice Address - Street 2:STE 100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3243
Practice Address - Country:US
Practice Address - Phone:561-845-6000
Practice Address - Fax:561-845-6916
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054822207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B98107Medicare UPIN
FL08309ZMedicare ID - Type Unspecified