Provider Demographics
NPI:1043233646
Name:MARTIN, DIBE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIBE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SW 62ND PLACE
Mailing Address - Street 2:SUITE PHE
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-662-6367
Mailing Address - Fax:305-662-6370
Practice Address - Street 1:7300 SW 62ND PLACE
Practice Address - Street 2:SUITE PHE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-662-6367
Practice Address - Fax:305-662-6370
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073050174400000X
FLME73050207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252425200Medicaid
FL252425200Medicaid