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General NPI Number Information
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NPI Number | 1316980824
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Entity Type | Individual
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Provider Name | SANDY MARTIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 05/26/2018
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Provider Practice Location Address
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Address Line | 1090 CAMELOT CIR
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City | NAPLES
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State | FL
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Zip | 34119
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Country | US
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Telephone | 561-706-5422
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Fax | 888-257-5932
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Provider Business Mailing Address
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Address Line | 1090 CAMELOT CIR
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City | NAPLES
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State | FL
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Zip | 34119-1308
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Country | US
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Telephone | 561-706-5422
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Fax | 888-990-1670
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 30746
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License Number State | FL
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