Provider Demographics
NPI:1194993113
Name:PETER B MCKERNAN MD DDS PA
Entity type:Organization
Organization Name:PETER B MCKERNAN MD DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS PA
Authorized Official - Phone:813-884-4967
Mailing Address - Street 1:6101 WEBB RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2872
Mailing Address - Country:US
Mailing Address - Phone:813-884-4967
Mailing Address - Fax:813-889-0847
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:SUITE 211
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-884-4967
Practice Address - Fax:813-889-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty