Healthcare Provider Details

I. General information

NPI: 1750353322
Provider Name (Legal Business Name): ISMAEL MARTIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD FL 3
NAPLES FL
34119-3900
US

IV. Provider business mailing address

311 9TH ST N SUITE 100
NAPLES FL
34102
US

V. Phone/Fax

Practice location:
  • Phone: 239-315-7123
  • Fax: 239-315-7122
Mailing address:
  • Phone: 239-624-8250
  • Fax: 239-430-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number100527
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS9649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: