Provider Demographics
NPI:1275579328
Name:PETER MARTINEZ-NODA DO PA
Entity Type:Organization
Organization Name:PETER MARTINEZ-NODA DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ NODA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-273-4454
Mailing Address - Street 1:7000 SW 97TH AVE
Mailing Address - Street 2:SUITE101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1494
Mailing Address - Country:US
Mailing Address - Phone:305-273-4454
Mailing Address - Fax:305-273-4453
Practice Address - Street 1:7000 SW 97TH AVE
Practice Address - Street 2:SUITE101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1494
Practice Address - Country:US
Practice Address - Phone:305-273-4454
Practice Address - Fax:305-273-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80794AMedicare ID - Type UnspecifiedMEDICARE
FLF59186Medicare UPIN