Healthcare Provider Details

I. General information

NPI: 1730575002
Provider Name (Legal Business Name): GULF UROLOGY OF ENGLEWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 ENGLEWOOD RD SUITE 3
ENGLEWOOD FL
34223-1749
US

IV. Provider business mailing address

2061 ENGLEWOOD RD SUITE 3
ENGLEWOOD FL
34223-1749
US

V. Phone/Fax

Practice location:
  • Phone: 941-473-1900
  • Fax: 941-475-0801
Mailing address:
  • Phone: 941-473-1900
  • Fax: 941-475-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberOS13122
License Number StateFL

VIII. Authorized Official

Name: DR. SCOTT T MARTZ
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 941-473-1900