MEDICARE: EDWIN R MARTINEZ MEJIAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	L3390	TX
2	207RC0000X	Cardiovascular Disease Physician	ME95229	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	060070478	OTHER	TX	RAILROAD MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0038QR	OTHER	TX	BCBS OF TEXAS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8F4950	OTHER	TX	BCBS OF TEXAS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124115514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN R MARTINEZ MEJIAS MD

Provider Business Mailing Address
First Line	:	483 N SEMORAN BLVD
Second Line	:	STE 102
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3800
Country	:	US
Telephone Number	:	407-571-1056
Fax Number	:	321-274-0322

Provider Business Practice Location Address
First Line	:	7806 LAKE UNDERHILL RD STE 105
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8232
Country	:	US
Telephone Number	:	407-601-0888
Fax Number	:	407-601-0931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/02/2019

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Directions to “ EDWIN R MARTINEZ MEJIAS MD” Practice Location

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