Healthcare Provider Details

I. General information

NPI: 1861710881
Provider Name (Legal Business Name): JOHN J MARTIN JR MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ALHAMBRA CIR
CORAL GABLES FL
33134-5003
US

IV. Provider business mailing address

325 ALHAMBRA CIR
CORAL GABLES FL
33134-5003
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-5950
  • Fax: 305-444-8670
Mailing address:
  • Phone: 305-444-5950
  • Fax: 305-444-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME 47615
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME47615
License Number StateFL

VIII. Authorized Official

Name: JOHN J MARTIN
Title or Position: PRESIDENT
Credential: MD, PA
Phone: 305-444-5950