Provider Demographics
NPI:1629115100
Name:MARTINEZ, LUIS GERARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GERARDO
Last Name:MARTINEZ
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 1:2600 S DOUGLAS RD STE 308
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6134
Mailing Address - Country:US
Mailing Address - Phone:305-913-9441
Mailing Address - Fax:305-442-1198
Practice Address - Street 1:16795 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-913-7300
Practice Address - Fax:305-362-9776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97578208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 97578OtherMEDICAL LICENSE
FL023166800Medicaid
FLME 97578OtherMEDICAL LICENSE
FM278674500Medicaid