Provider Demographics
NPI:1568769180
Name:HALLAM, MARTIN JOEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOEL
Last Name:HALLAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6310 HEALTH PARK WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5177
Mailing Address - Country:US
Mailing Address - Phone:941-348-1144
Mailing Address - Fax:941-213-6957
Practice Address - Street 1:6310 HEALTH PARK WAY STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-348-1144
Practice Address - Fax:941-213-6957
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005234A207VX0000X
FLOS13171207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics