Provider Demographics
NPI:1942205364
Name:ACKERMAN, SCOT N (MD)
Entity Type:Individual
Prefix:
First Name:SCOT
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 1:10881 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6612
Mailing Address - Country:US
Mailing Address - Phone:904-880-5522
Mailing Address - Fax:904-880-5533
Practice Address - Street 1:10881 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6612
Practice Address - Country:US
Practice Address - Phone:904-880-5522
Practice Address - Fax:904-880-5533
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME529562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00457553AMedicaid
FL3602303OtherUNITED HEALTHCARE
FL4000116OtherG H I
FL140375200OtherCIGNA
FL206922OtherAVMED
FL28751OtherWELLCARE
FL379520900Medicaid
FL08427OtherHEALTHEASE
FL300019643OtherRAILROAD MEDICARE
FL28751OtherWELLCARE
FL300019643OtherRAILROAD MEDICARE