Provider Demographics
NPI:1780863894
Name:MARTIN, DAVID LEE (AP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 WINKLER RD
Mailing Address - Street 2:STE #2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7274
Mailing Address - Country:US
Mailing Address - Phone:239-277-1399
Mailing Address - Fax:
Practice Address - Street 1:6710 WINKLER RD
Practice Address - Street 2:STE. #2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7274
Practice Address - Country:US
Practice Address - Phone:239-277-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist