Healthcare Provider Details

I. General information

NPI: 1962848200
Provider Name (Legal Business Name): CHARLES DEE MARTIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY MEDICINE RESIDENCY NH PENSACOLA 6000 W. HWY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

FAMILY MEDICINE RESIDENCY NH PENSACOLA 6000 W. HWY 98
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6472
  • Fax:
Mailing address:
  • Phone: 850-505-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: