Healthcare Provider Details

I. General information

NPI: 1326219627
Provider Name (Legal Business Name): JOEL L MARTIN M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 HOLLYWOOD BLVD STE 3A
HOLLYWOOD FL
33021-6749
US

IV. Provider business mailing address

3939 HOLLYWOOD BLVD STE 3A
HOLLYWOOD FL
33021-6749
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-7700
  • Fax: 954-961-0092
Mailing address:
  • Phone: 954-961-7700
  • Fax: 954-961-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME0016209
License Number StateFL

VIII. Authorized Official

Name: JOEL L MARTIN
Title or Position: PRESIDENT
Credential: M D P A
Phone: 954-961-7700