Provider Demographics
NPI:1245222355
Name:EDEP, MARTIN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:EDWARD
Last Name:EDEP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NW 9TH CT
Mailing Address - Street 2:STE 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2268
Mailing Address - Country:US
Mailing Address - Phone:561-395-4600
Mailing Address - Fax:561-395-6903
Practice Address - Street 1:1000 NW 9TH CT
Practice Address - Street 2:STE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2268
Practice Address - Country:US
Practice Address - Phone:561-395-4600
Practice Address - Fax:561-395-6903
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0075950207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254520900Medicaid
F93557Medicare UPIN
FLE0662Medicare ID - Type Unspecified