MEDICARE: MR. EDOUARD RENE MARTIN 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	207RN0300X	Nephrology Physician	ME59266	FL
2	207R00000X	Internal Medicine Physician	ME59266	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	12490	OTHER	FL	BCBS
3	205874	OTHER	FL	AV MED
4	1000619	OTHER	FL	CAREPLUS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831182880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDOUARD RENE MARTIN M.D.

Provider Business Mailing Address
First Line	:	2951 NW 49TH AVE.
Second Line	:	#101
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313
Country	:	US
Telephone Number	:	954-739-2511
Fax Number	:	954-739-9239

Provider Business Practice Location Address
First Line	:	2951 NW 49TH AVE.
Second Line	:	SUITE #101
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313
Country	:	US
Telephone Number	:	954-739-2511
Fax Number	:	954-739-9239

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/22/2010

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Directions to “ MR. EDOUARD RENE MARTIN M.D.” Practice Location

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