Provider Demographics
NPI:1861440935
Name:MARTINEZ-NODA, PETER A (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:MARTINEZ-NODA
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 1:7000 SW 97TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1474
Mailing Address - Country:US
Mailing Address - Phone:305-273-4454
Mailing Address - Fax:305-273-4453
Practice Address - Street 1:7000 SW 97TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1474
Practice Address - Country:US
Practice Address - Phone:305-273-4454
Practice Address - Fax:305-273-4453
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006254207Q00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372944300Medicaid
FL372944301Medicaid
FL372944300Medicaid