Provider Demographics
NPI:1407925381
Name:DR. DAVID C. MARTIN, DPM,PL
Entity Type:Organization
Organization Name:DR. DAVID C. MARTIN, DPM,PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-540-9049
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-0056
Mailing Address - Country:US
Mailing Address - Phone:275-725-4497
Mailing Address - Fax:727-844-5425
Practice Address - Street 1:905 E MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4864
Practice Address - Country:US
Practice Address - Phone:727-572-5449
Practice Address - Fax:727-844-5425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2502213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390279000Medicaid
FLU58809Medicare UPIN
FL390279000Medicaid
FL65412UMedicare PIN