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General NPI Number Information
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NPI Number | 1467643221
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Entity Type | Individual
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Provider Name | SEAN NICHOLAS MARTIN D.O
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Gender | Male
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 17425 7TH ST STE 560174
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City | MONTVERDE
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State | FL
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Zip | 34756-3206
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Country | US
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Telephone | 407-544-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 17425 7TH ST STE 560174
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City | MONTVERDE
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State | FL
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Zip | 34756-3206
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Country | US
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Telephone | 407-544-0166
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS10526
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License Number State | FL
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