Provider Demographics
NPI:1659363851
Name:RICHMAN, MARTIN B (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:B
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:1840 MEASE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34595
Practice Address - Country:US
Practice Address - Phone:727-785-6011
Practice Address - Fax:727-787-6951
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME92031208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I32635Medicare UPIN
FLU48542Medicare ID - Type Unspecified