Healthcare Provider Details

I. General information

NPI: 1609016849
Provider Name (Legal Business Name): JOSE ANGEL MARTIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2009
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 NumberOS 12458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: