MEDICARE: DR. EMANUEL MARTINEZ 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	2084P0800X	Psychiatry Physician	68758	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27411	OTHER	FL	BCBS OF FLORIDA PROVIDER

General Provider Information

NPI Number	:	1548264518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMANUEL MARTINEZ M.D.

Provider Business Mailing Address
First Line	:	315 W TOWN PL
Second Line	:	SUITE 3
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3104
Country	:	US
Telephone Number	:	904-940-2200
Fax Number	:	904-940-2201

Provider Business Practice Location Address
First Line	:	315 W TOWN PL
Second Line	:	SUITE 3
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3104
Country	:	US
Telephone Number	:	904-940-2200
Fax Number	:	904-940-2201

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	12/17/2013

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