Healthcare Provider Details

I. General information

NPI: 1679579676
Provider Name (Legal Business Name): JOEL L MARTIN M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date: 03/21/2006
Reactivation Date: 03/29/2006

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:
Title or Position:
Credential:
Phone: