MEDICARE: MARTIN IRA PERLMUTTER M.D.

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	174400000X	Specialist	MD012579	TN
2	174400000X	Specialist	ME80465	FL

General Provider Information

NPI Number	:	1487659843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN IRA PERLMUTTER M.D.

Provider Business Mailing Address
First Line	:	12591 SORRENTO RD
Second Line	:	SUITE B
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8754
Country	:	US
Telephone Number	:	850-497-0711
Fax Number	:	850-497-0733

Provider Business Practice Location Address
First Line	:	12591 SORRENTO RD
Second Line	:	SUITE B
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8754
Country	:	US
Telephone Number	:	850-497-0711
Fax Number	:	850-497-0733

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	01/06/2015

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