Healthcare Provider Details

I. General information

NPI: 1194827329
Provider Name (Legal Business Name): WALTER C MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4631 N CONGRESS AVE 200
WEST PALM BEACH FL
33407
US

IV. Provider business mailing address

4631 N CONGRESS AVE 200
WEST PALM BEACH FL
33407
US

V. Phone/Fax

Practice location:
  • Phone: 561-845-0500
  • Fax: 561-296-1101
Mailing address:
  • Phone: 561-845-0500
  • Fax: 561-296-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME 27021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: