Provider Demographics
NPI:1063481638
Name:R M ORTHOPEDICS PA
Entity Type:Organization
Organization Name:R M ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:238-368-5777
Mailing Address - Street 1:1530 LEE BLVD
Mailing Address - Street 2:#1300
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4893
Mailing Address - Country:US
Mailing Address - Phone:239-368-5777
Mailing Address - Fax:239-368-5972
Practice Address - Street 1:1530 LEE BLVD
Practice Address - Street 2:#1300
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4893
Practice Address - Country:US
Practice Address - Phone:239-368-5777
Practice Address - Fax:239-368-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49725174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02501OtherBLUE CROSS BLUE SHIELD
FL262831700Medicaid
FL4240150OtherAETNA
FL160021OtherWELLCARE
FL5356550001Medicare NSC
FL160021OtherWELLCARE