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General NPI Number Information
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NPI Number | 1275516999
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Entity Type | Individual
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Provider Name | LILLA GAYLE MARTIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32610-3003
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Country | US
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Telephone | 352-273-9079
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Fax | 352-273-8889
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Provider Business Mailing Address
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Address Line | 1893 KINGSLEY AVE SUITE B
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City | ORANGE PARK
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State | FL
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Zip | 32073-4491
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Country | US
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Telephone | 904-272-6955
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Fax | 904-272-5001
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME30921
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME0030921
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License Number State | FL
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