Provider Demographics
NPI:1053314302
Name:MARTIN, JAMES PETER (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PETER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11037
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1037
Mailing Address - Country:US
Mailing Address - Phone:850-444-4700
Mailing Address - Fax:850-444-7497
Practice Address - Street 1:1619 CREIGHTON RD STE 1
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7152
Practice Address - Country:US
Practice Address - Phone:850-444-4700
Practice Address - Fax:850-434-8144
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1286207RN0300X
FLOS3923207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51866OtherBLUE CROSS BLUE SHIELDS
ALDO.1286OtherMEDICAL LICENSE
FLOS3923OtherMEDICAL LICENSE
FL110233261OtherFLORIDA RR MEDICARE
FL261540100Medicaid
FL110233261OtherFLORIDA RR MEDICARE
FL261540100Medicaid
FL261540100Medicaid
FL51866OtherBLUE CROSS BLUE SHIELDS
FLC48064Medicare UPIN
FL51866XMedicare PIN
FL110233261OtherFLORIDA RR MEDICARE