Provider Demographics
NPI:1467474767
Name:MARTIN, ANDRES E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:E
Last Name:MARTIN
Suffix:JR
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 1:4421 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2166
Mailing Address - Country:US
Mailing Address - Phone:863-314-4357
Mailing Address - Fax:863-382-1279
Practice Address - Street 1:4024 CENTRAL AVE
Practice Address - Street 2:SUNCOAST CETNER, INC.
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1239
Practice Address - Country:US
Practice Address - Phone:727-327-7656
Practice Address - Fax:727-322-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83254174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266619700Medicaid
FLE920872OtherUPIN
FL12652Medicaid
FL12652OtherBLUE CROSS BLUE SHIELD
FL266619700Medicaid
FL12652Medicare ID - Type Unspecified
FL12652YMedicare PIN