Healthcare Provider Details

I. General information

NPI: 1558460105
Provider Name (Legal Business Name): ALEX J MARTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 VENTURA CT
PARKLAND FL
33067-2339
US

IV. Provider business mailing address

7001 VENTURA CT
PARKLAND FL
33067-2339
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-2200
  • Fax:
Mailing address:
  • Phone: 954-721-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME0042319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: