Provider Demographics
NPI:1558460105
Name:MARTI, ALEX J (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:J
Last Name:MARTI
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 1:7001 VENTURA CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2339
Mailing Address - Country:US
Mailing Address - Phone:954-721-2200
Mailing Address - Fax:
Practice Address - Street 1:7001 VENTURA CT
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2339
Practice Address - Country:US
Practice Address - Phone:954-721-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00423192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94561OtherBLUE SHIELD
FLP00252522OtherRR MEDICARE
FLP00252522OtherRR MEDICARE
DCAM2182816OtherDEA
FLD64733Medicare UPIN