Healthcare Provider Details

I. General information

NPI: 1194837971
Provider Name (Legal Business Name): SAMUEL C. MARTINO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7229 US HIGHWAY 301 S
RIVERVIEW FL
33578-4346
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-677-8418
  • Fax: 813-355-5906
Mailing address:
  • Phone: 813-528-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0003607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: