Healthcare Provider Details

I. General information

NPI: 1558634048
Provider Name (Legal Business Name): MARTIN J. MILNE, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25400 US HIGHWAY 19 N STE 201
CLEARWATER FL
33763-2144
US

IV. Provider business mailing address

25400 US HIGHWAY 19 N STE 201
CLEARWATER FL
33763-2144
US

V. Phone/Fax

Practice location:
  • Phone: 727-669-6411
  • Fax: 727-669-8231
Mailing address:
  • Phone: 727-669-6411
  • Fax: 727-669-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberME0076664
License Number StateFL

VIII. Authorized Official

Name: DR. MARTIN JOSEPH MILNE
Title or Position: OWNER
Credential: MD.
Phone: 727-669-6411