1093275927 NPI number — DR. JONATHAN EDWARD AKER MD

Table of content: DR. JONATHAN EDWARD AKER MD (NPI 1093275927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093275927 NPI number — DR. JONATHAN EDWARD AKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKER
Provider First Name:
JONATHAN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093275927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3649 N OCEAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULF STREAM
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33483-7438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-501-1333
Provider Business Mailing Address Fax Number:
561-338-7722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1445 NW BOCA RATON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33432-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-338-7722
Provider Business Practice Location Address Fax Number:
561-338-7785
Provider Enumeration Date:
03/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 162548 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 118959800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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