Healthcare Provider Details

I. General information

NPI: 1720236003
Provider Name (Legal Business Name): GERARD J. MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8665 NW 186TH ST
HIALEAH FL
33015-2553
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 305-682-7262
  • Fax: 954-276-7047
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME114724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: