Provider Demographics
NPI:1679579676
Name:MARTIN, JOEL L (M D)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 HOLLYWOOD BLVD
Mailing Address - Street 2:STE 3A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6749
Mailing Address - Country:US
Mailing Address - Phone:954-961-7700
Mailing Address - Fax:954-961-0092
Practice Address - Street 1:3939 HOLLYWOOD BLVD
Practice Address - Street 2:STE 3A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6749
Practice Address - Country:US
Practice Address - Phone:954-961-7700
Practice Address - Fax:954-961-0092
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2021-12-22
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
FLME0016209208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL341998433OtherRR MEDICARE
FL1902072OtherUNITED
FL203294OtherAVMED
FL06844OtherB/S
FL0065443OtherGHI
FL4068841OtherAETNA
FL049413500Medicaid
FL341998433OtherRR MEDICARE
FL4068841OtherAETNA