Provider Demographics
NPI:1699720367
Name:AKERSON, MARK R (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:AKERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4250 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1917
Mailing Address - Country:US
Mailing Address - Phone:850-482-2910
Mailing Address - Fax:850-482-2836
Practice Address - Street 1:4284 KELSON AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2948
Practice Address - Country:US
Practice Address - Phone:850-482-2910
Practice Address - Fax:850-482-2836
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL84170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13613OtherBLUECROSS BLUESHIELD FLORIDA
FL13613ZOtherMEDICARE PTAN
FL264599800Medicaid
P00042967OtherMEDICARE RAILROAD
FL13613ZOtherMEDICARE PTAN
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