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General NPI Number Information
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NPI Number | 1801171830
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Entity Type | Organization
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Legal Business Name | MARTIN DERMATOLOGY, PL
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 951 BRICKELL AVE 1707
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City | MIAMI
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State | FL
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Zip | 33131-3930
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Country | US
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Telephone | 305-742-6481
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Fax |
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Provider Business Mailing Address
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Address Line | 951 BRICKELL AVE 1707
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City | MIAMI
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State | FL
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Zip | 33131-3930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUCY K MARTIN
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Credential | M.D.
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Telephone | 305-742-6481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME103509
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License Number State | FL
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