Healthcare Provider Details

I. General information

NPI: 1215914593
Provider Name (Legal Business Name): MARTHA M COETZEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 W OAK ST
ARCADIA FL
34266-3369
US

IV. Provider business mailing address

1012 W OAK ST
ARCADIA FL
34266-3369
US

V. Phone/Fax

Practice location:
  • Phone: 561-843-3775
  • Fax:
Mailing address:
  • Phone: 561-843-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042.0012753
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME96316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: