Provider Demographics
NPI:1598781924
Name:BRITOS-BRAY, MARTIN FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:FERNANDO
Last Name:BRITOS-BRAY
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 1:13067 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0926
Mailing Address - Country:US
Mailing Address - Phone:813-779-6303
Mailing Address - Fax:786-868-0012
Practice Address - Street 1:2700 HEALING WAY STE 112
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5453
Practice Address - Country:US
Practice Address - Phone:813-929-5226
Practice Address - Fax:813-929-5223
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109247207RC0200X, 207RP1001X, 207RP1001X, 208M00000X, 207RC0200X
MDD64732207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003335300Medicaid
MD020217200Medicaid
MD887377-03 & 04OtherBLUE CROSS/BLUE SHIELD - REGIONAL
MDP00776269Medicare PIN
MD136192ZA0TMedicare PIN
MD887377-03 & 04OtherBLUE CROSS/BLUE SHIELD
FLEV194ZMedicare PIN