Healthcare Provider Details

I. General information

NPI: 1275516999
Provider Name (Legal Business Name): LILLA GAYLE MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1893 KINGSLEY AVE SUITE B
ORANGE PARK FL
32073-4491
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9079
  • Fax: 352-273-8889
Mailing address:
  • Phone: 904-272-6955
  • Fax: 904-272-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME30921
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0030921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: