Provider Demographics
NPI:1326219627
Name:JOEL L MARTIN M D P A
Entity Type:Organization
Organization Name:JOEL L MARTIN M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D P A
Authorized Official - Phone:954-961-7700
Mailing Address - Street 1:3939 HOLLYWOOD BLVD
Mailing Address - Street 2:STE 3A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6749
Mailing Address - Country:US
Mailing Address - Phone:954-961-7700
Mailing Address - Fax:954-961-0092
Practice Address - Street 1:3939 HOLLYWOOD BLVD
Practice Address - Street 2:STE 3A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6749
Practice Address - Country:US
Practice Address - Phone:954-961-7700
Practice Address - Fax:954-961-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016209208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049413500Medicaid
FL06844OtherB/S
FL203294OtherAVMED
FL4068841OtherAETNA
FL341998433OtherRR MEDICARE
FL1902072OtherUNITED
FL0065443OtherGHI
FL341998433OtherRR MEDICARE
FL06844OtherB/S
FLD51736Medicare UPIN