MEDICARE: DR. SETH ALEXANDER MARTIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME123784	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255697504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH ALEXANDER MARTIN M.D.

Provider Business Mailing Address
First Line	:	12348 SW KEATING DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-2170
Country	:	US
Telephone Number	:	713-444-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	12348 SW KEATING DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-2170
Country	:	US
Telephone Number	:	713-444-9010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	04/25/2017

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