Healthcare Provider Details

I. General information

NPI: 1124584909
Provider Name (Legal Business Name): MARTIN SURGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 04/15/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 N UNIVERSITY DR STE 305
TAMARAC FL
33321-6102
US

IV. Provider business mailing address

7421 N UNIVERSITY DR STE 305
TAMARAC FL
33321-6102
US

V. Phone/Fax

Practice location:
  • Phone: 954-233-0913
  • Fax: 954-391-5011
Mailing address:
  • Phone: 954-233-0913
  • Fax: 954-391-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE A MARTIN
Title or Position: PRESIDENT
Credential: DO
Phone: 954-233-0913