Provider Demographics
NPI:1609988120
Name:MARTINEZ,, LUCIANO A JR (MD)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:A
Last Name:MARTINEZ,
Suffix:JR
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 1:2727 W. DR. MLK JR. BLVD
Mailing Address - Street 2:SUITE 630
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6383
Mailing Address - Country:US
Mailing Address - Phone:813-876-6000
Mailing Address - Fax:813-876-0590
Practice Address - Street 1:2727 W. DR. MLK JR. BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-876-6000
Practice Address - Fax:813-876-0590
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064971600Medicaid
FL374439600Medicaid
D62173Medicare UPIN
FL374439600Medicaid
FL064971600Medicaid