Healthcare Provider Details

I. General information

NPI: 1972616852
Provider Name (Legal Business Name): GILBERTO J MARTORELL-MARQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GABLE COURT
BRUNSWICK GA
31525-6738
US

IV. Provider business mailing address

11 GABLE COURT
BRUNSWICK GA
31525-6738
US

V. Phone/Fax

Practice location:
  • Phone: 912-778-3556
  • Fax: 912-778-3558
Mailing address:
  • Phone: 912-466-5870
  • Fax: 912-466-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number027088
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: