Basic Information
| Provider Information | |||||||||
| NPI: | 1366684615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACKERMAN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 GULF BLVD | ||||||||
| Address2: | UNIT 503 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337672900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8426427114 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6500 38TH AVE N | ||||||||
| Address2: | ST. PETERSBURG GENERAL HOSPITAL EMERGENCY DEPARTMENT | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337101629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273841414 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 11/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME113358 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.