Provider Demographics
NPI:1114176567
Name:WHITMAN, MARTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 35TH AVE STE 465
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5467
Mailing Address - Country:US
Mailing Address - Phone:954-986-9008
Mailing Address - Fax:954-986-6646
Practice Address - Street 1:1150 N 35TH AVE STE 465
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5467
Practice Address - Country:US
Practice Address - Phone:954-986-9008
Practice Address - Fax:954-986-6646
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA192573473AMedicaid
FL0012269-00Medicaid
FLE2410XMedicare PIN
GA192573473AMedicaid