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General NPI Number Information
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NPI Number | 1619393998
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Entity Type | Individual
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Provider Name | JEFFREY DEAN MARTINS SA-C
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Gender | Male
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 6705 SW 57TH AVE STE 501
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3644
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Country | US
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Telephone | 786-471-4299
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Fax | 305-397-1154
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Provider Business Mailing Address
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Address Line | 6705 SW 57TH AVE STE 501
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3644
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Country | US
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Telephone | 786-471-4299
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Fax | 305-397-1154
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 14-126
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License Number State | FL
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