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General NPI Number Information
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NPI Number | 1851556211
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Entity Type | Organization
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Legal Business Name | EMANUEL MARTINEZ MD AND ASSOCIATES
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 1555 KINGSLEY AVE SUITE 101
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City | ORANGE PARK
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State | FL
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Zip | 32073-4560
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Country | US
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Telephone | 904-278-4999
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Fax | 904-278-8891
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Provider Business Mailing Address
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Address Line | PO BOX 457
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City | ORANGE PARK
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State | FL
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Zip | 32067-0457
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Country | US
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Telephone | 904-278-4999
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Fax | 904-278-8891
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. EMANUEL MARTINEZ
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Credential | M.D.
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Telephone | 904-278-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME68758
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License Number State | FL
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