Provider Demographics
NPI:1508919986
Name:MARTINEZ, FEDERICO JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:JORGE
Last Name:MARTINEZ
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 1:2500 N MILITARY TRL STE 310
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6324
Mailing Address - Country:US
Mailing Address - Phone:954-573-5464
Mailing Address - Fax:
Practice Address - Street 1:3905 NW 107TH AVE STE 305
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2785
Practice Address - Country:US
Practice Address - Phone:954-573-5464
Practice Address - Fax:561-210-7112
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57886208000000X
FLME0057886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE55285Medicare UPIN