Provider Demographics
NPI:1710320742
Name:GUERRERO, MARTIN ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ALEXANDER
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUSTAVO
Other - Middle Name:MARTIN
Other - Last Name:LACAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 TAMPA GENERAL CIR # 750
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3601
Practice Address - Country:US
Practice Address - Phone:813-844-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2017-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131499208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021752000Medicaid
FLDVBHXOtherBLUE CROSS BLUE SHIELD