Provider Demographics
NPI:1508842204
Name:MARTIN, PLUNKETT, MD, LLC
Entity Type:Organization
Organization Name:MARTIN, PLUNKETT, MD, LLC
Other - Org Name:MARTIN AND PLUNKETT, M.D., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-477-5437
Mailing Address - Street 1:545 BRENT LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2003
Mailing Address - Country:US
Mailing Address - Phone:850-477-5437
Mailing Address - Fax:850-477-3380
Practice Address - Street 1:545 BRENT LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2003
Practice Address - Country:US
Practice Address - Phone:850-477-5437
Practice Address - Fax:850-477-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77493OtherBLUE CROSS BLUE SHIELD
FL378063500Medicaid
AL529913170Medicaid
FLCK5465OtherMEDICARE RAILROAD
FLCK5465OtherMEDICARE RAILROAD
ALJ145Medicare ID - Type Unspecified