=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720280969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RALPH J. MARTIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2007
-----------------------------------------------------
Last Update Date | 01/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3339 TAMIAMI TRL E STE 145
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34112-5361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-252-5365
-----------------------------------------------------
Fax | 239-896-1902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3339 TAMIAMI TRL E STE 145
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34112-5361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-252-5365
-----------------------------------------------------
Fax | 239-896-1902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 16762
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207UN0902X
-----------------------------------------------------
Taxonomy Name | Nuclear Imaging & Therapy Physician
-----------------------------------------------------
License Number | ME129077
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207UN0902X
-----------------------------------------------------
Taxonomy Name | Nuclear Imaging & Therapy Physician
-----------------------------------------------------
License Number | 16762
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME129077
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------