Provider Demographics
NPI:1912028101
Name:MARTIN, AIMEE JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:JOY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2360
Mailing Address - Country:US
Mailing Address - Phone:561-889-6320
Mailing Address - Fax:941-753-2800
Practice Address - Street 1:2215 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2360
Practice Address - Country:US
Practice Address - Phone:561-889-6320
Practice Address - Fax:941-753-2800
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000812900Medicaid
FLAI0522OtherMEDICARE PTAN