MEDICARE: MR. JEFFREY DEAN MARTINS SA-C

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	246ZC0007X	Surgical Assistant	14-126	FL

General Provider Information

NPI Number	:	1619393998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY DEAN MARTINS SA-C

Provider Business Mailing Address
First Line	:	6705 SW 57TH AVE STE 501
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-3644
Country	:	US
Telephone Number	:	786-471-4299
Fax Number	:	305-397-1154

Provider Business Practice Location Address
First Line	:	6705 SW 57TH AVE STE 501
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-3644
Country	:	US
Telephone Number	:	786-471-4299
Fax Number	:	305-397-1154

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

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	03/11/2014

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