Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G35691 | CA |
Y | 208600000X | Surgeon | G35691 | CA |
N | 2086S0127X | Trauma Surgeon | G35691 | CA |
N | 2086S0129X | Vascular Surgeon | G35691 | CA |
NPI | 1003831447 |
---|---|
Provider Name | Brian J. Acker |
First Address | Long Beach, CA 90806-1740 |
Second Address | Long Beach, CA 90806-1740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 09/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G356910 | (05) | CA |
A46441 | (02) | CA |