Provider Demographics
NPI:1295998037
Name:CANILLAS, MARTIN ROJAS (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ROJAS
Last Name:CANILLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-799-0042
Practice Address - Street 1:14555 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6003
Practice Address - Country:US
Practice Address - Phone:352-556-4823
Practice Address - Fax:352-556-4824
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME123994207QS0010X
OK26447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1213ROtherBLUE CROSS BLUE SHIELD
FL015444400Medicaid