Healthcare Provider Details

I. General information

NPI: 1801007190
Provider Name (Legal Business Name): KEITH R MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 GALL BLVD
ZEPHYRHILLS FL
33541-1347
US

IV. Provider business mailing address

7050 GALL BLVD
ZEPHYRHILLS FL
33541-1347
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-8761
  • Fax:
Mailing address:
  • Phone: 813-782-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number036084645
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME173799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: