Healthcare Provider Details

I. General information

NPI: 1831538081
Provider Name (Legal Business Name): GRACIA MARTIN PIERRE-PIERRE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9955 SE FEDERAL HWY STE B
HOBE SOUND FL
33455-4800
US

IV. Provider business mailing address

1050 SE MONTEREY RD STE 400
STUART FL
34994-4512
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2400
  • Fax:
Mailing address:
  • Phone: 772-288-2400
  • Fax: 772-419-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME 119703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: