Provider Demographics
NPI:1447216908
Name:MARTIN, JORGE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:R
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 1:844 SW 161ST AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1078
Mailing Address - Country:US
Mailing Address - Phone:954-499-7944
Mailing Address - Fax:954-538-0767
Practice Address - Street 1:3000 SW 148TH AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4169
Practice Address - Country:US
Practice Address - Phone:954-499-7944
Practice Address - Fax:954-538-0767
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 81470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH66348Medicare UPIN