Provider Demographics
NPI:1689885691
Name:MARTIN, LUCY KRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:KRISTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BRICKELL AVE
Mailing Address - Street 2:APT 1707
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3930
Mailing Address - Country:US
Mailing Address - Phone:305-742-6481
Mailing Address - Fax:
Practice Address - Street 1:2645 SW 37TH AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2754
Practice Address - Country:US
Practice Address - Phone:305-444-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103509207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCRO4OZMedicare PIN
FLCRO4OXMedicare PIN