Provider Demographics
NPI:1821378589
Name:CLEMMONS, MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:CLEMMONS
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 1:2025 INDIAN ROCKS RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1035
Mailing Address - Country:US
Mailing Address - Phone:727-586-7103
Mailing Address - Fax:727-585-7205
Practice Address - Street 1:2025 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1035
Practice Address - Country:US
Practice Address - Phone:727-586-7103
Practice Address - Fax:727-585-7205
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO2834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine