Provider Demographics
NPI:1760462386
Name:HARLAND, MARTIN TRACY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:TRACY
Last Name:HARLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-7808
Mailing Address - Country:US
Mailing Address - Phone:561-996-2024
Mailing Address - Fax:561-996-8536
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-7808
Practice Address - Country:US
Practice Address - Phone:561-992-8000
Practice Address - Fax:561-992-8020
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-0005579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21281OtherMEDICARE GROUP NUMBER
FL253267100OtherMEDICAID GROUP NUMBER
FL064629600Medicaid
FL1760462386OtherMEDICAER NPI HARLAND
FL21281AOtherMEDICARE GROUP NUMBER
FL1992785513OtherMEDICARE GROUP NPI
FL1760462386OtherMEDICAER NPI HARLAND
FL21281AOtherMEDICARE GROUP NUMBER
FL80206YMedicare PIN