Provider Demographics
NPI:1407918352
Name:MARTIN, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:305 MEMORIAL MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-231-3540
Mailing Address - Fax:386-231-3544
Practice Address - Street 1:873 STERTHAUS AVE
Practice Address - Street 2:#303
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5189
Practice Address - Country:US
Practice Address - Phone:386-671-6591
Practice Address - Fax:386-671-6598
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-09-03
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Provider Licenses
StateLicense IDTaxonomies
FLME 98396207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000765058AMedicaid
F27488Medicare UPIN
GA14BDCFGMedicare ID - Type Unspecified