Healthcare Provider Details

I. General information

NPI: 1548264518
Provider Name (Legal Business Name): EMANUEL MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W TOWN PL SUITE 3
ST AUGUSTINE FL
32092-3104
US

IV. Provider business mailing address

315 W TOWN PL SUITE 3
ST AUGUSTINE FL
32092-3104
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-2200
  • Fax: 904-940-2201
Mailing address:
  • Phone: 904-940-2200
  • Fax: 904-940-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number68758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: