Provider Demographics
NPI:1609016849
Name:MARTIN, JOSE ANGEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANGEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 N UNIVERSITY DR STE 305
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6102
Mailing Address - Country:US
Mailing Address - Phone:954-233-0913
Mailing Address - Fax:954-391-5011
Practice Address - Street 1:7421 N UNIVERSITY DR STE 305
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6102
Practice Address - Country:US
Practice Address - Phone:954-233-0913
Practice Address - Fax:954-391-5011
Is Sole Proprietor?:No
Enumeration Date:2009-02-28
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12458208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011955500Medicaid
FL011955500Medicaid