Provider Demographics
NPI:1750680856
Name:MARTINEZ, MARINO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:MARINO
Middle Name:ANTONIO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 KELCEY CT STE 203
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5986
Mailing Address - Country:US
Mailing Address - Phone:850-354-8387
Mailing Address - Fax:850-329-7878
Practice Address - Street 1:4012 KELCEY CT STE 203
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5968
Practice Address - Country:US
Practice Address - Phone:850-354-8387
Practice Address - Fax:850-329-7878
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110239207R00000X
FLPENDING208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist