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General NPI Number Information
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NPI Number | 1023639374
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Entity Type | Individual
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Provider Name | JORDAN MARTINEZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 40100 HIGHWAY 27
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City | DAVENPORT
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State | FL
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Zip | 33837-5906
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Country | US
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Telephone | 863-422-4971
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 337-609-4593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 58464
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME168592
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License Number State | FL
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