MEDICARE: DR. SUZANNE L MARTINEZ 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME49388	FL
2	207R00000X	Internal Medicine Physician	ME49388	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295759652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE L MARTINEZ MD

Provider Business Mailing Address
First Line	:	2021 PROFESSIONAL CENTER DR STE 100
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4461
Country	:	US
Telephone Number	:	904-777-2667
Fax Number	:	904-777-2069

Provider Business Practice Location Address
First Line	:	2021 PROFESSIONAL CENTER DR STE 100
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4461
Country	:	US
Telephone Number	:	904-777-2667
Fax Number	:	904-777-2069

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	12/21/2022

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