=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063481638
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R M ORTHOPEDICS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2006
-----------------------------------------------------
Last Update Date | 04/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1530 LEE BLVD #1300
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33936-4893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-368-5777
-----------------------------------------------------
Fax | 239-368-5972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1530 LEE BLVD #1300
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33936-4893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-368-5777
-----------------------------------------------------
Fax | 239-368-5972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT MARTINEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 238-368-5777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME49725
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------