Healthcare Provider Details

I. General information

NPI: 1437116464
Provider Name (Legal Business Name): ROBERT PAUL MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 UNIVERSITY BLVD W
JACKSONVILLE FL
32217-2176
US

IV. Provider business mailing address

2777 UNIVERSITY BLVD W STE 26
JACKSONVILLE FL
32217-2143
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0475
  • Fax: 904-633-0476
Mailing address:
  • Phone: 904-427-8026
  • Fax: 904-633-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME113535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: