Provider Demographics
NPI:1295826212
Name:MARTINEZ, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MARTINEZ
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 1:402 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3504
Mailing Address - Country:US
Mailing Address - Phone:813-223-4444
Mailing Address - Fax:813-229-9104
Practice Address - Street 1:402 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3504
Practice Address - Country:US
Practice Address - Phone:813-223-4444
Practice Address - Fax:813-229-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31847174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06610OtherUNIVERSAL HEALTH CARE
FL167374OtherWELL CARE
FLD85502Medicare UPIN
FL06610OtherUNIVERSAL HEALTH CARE