Provider Demographics
NPI:1376828970
Name:MARTIN, PEDRO PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:PABLO
Last Name:MARTIN
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 1:12264 TAMIAMI TRL E STE 203
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7942
Mailing Address - Country:US
Mailing Address - Phone:239-999-4949
Mailing Address - Fax:239-999-4959
Practice Address - Street 1:12264 TAMIAMI TRL E STE 203
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7942
Practice Address - Country:US
Practice Address - Phone:239-999-4949
Practice Address - Fax:239-999-4959
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113615207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14N0WOtherBCBS
FL006576400Medicaid
FLGM452VOtherMEDICARE
FLGM452VOtherMEDICARE