Healthcare Provider Details

I. General information

NPI: 1144683467
Provider Name (Legal Business Name): BRIAN JAMES MARTENS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

IV. Provider business mailing address

701 6TH ST S
ST PETERSBURG FL
33701-4814
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-6182
  • Fax: 727-893-6861
Mailing address:
  • Phone: 727-893-6182
  • Fax: 727-893-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberOS16338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: