Healthcare Provider Details

I. General information

NPI: 1043604259
Provider Name (Legal Business Name): ERNESTO MARTINEZ DUARTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100275
GAINESVILLE FL
32610
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-7787
  • Fax:
Mailing address:
  • Phone: 352-273-7839
  • Fax: 352-273-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME134802
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME134802
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number31898
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: