Provider Demographics
NPI:1689860421
Name:MARTINEZ IRIZARRY, AXEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:AXEL
Middle Name:E
Last Name:MARTINEZ IRIZARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9401 SW HIGHWAY 200 STE 6001
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-9654
Mailing Address - Country:US
Mailing Address - Phone:352-291-1300
Mailing Address - Fax:352-291-1323
Practice Address - Street 1:9401 SW HIGHWAY 200 STE 6001
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481
Practice Address - Country:US
Practice Address - Phone:352-291-1300
Practice Address - Fax:352-291-1323
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17055207Q00000X, 207QG0300X, 207QH0002X
TXN5844207Q00000X, 207QG0300X, 207QH0002X
FLME127807207QG0300X, 207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102876Medicare PIN