Provider Demographics
NPI:1942205992
Name:MARTENS, HAL FREDRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:FREDRICK
Last Name:MARTENS
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 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:9375 EMERALD COAST PKWY W STE 1
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7275
Practice Address - Country:US
Practice Address - Phone:850-278-3460
Practice Address - Fax:850-278-3459
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18220207RR0500X
TXN5223207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L23563OtherINDIVIDUAL PTAN
MI2755570Medicaid
MIB49015Medicare UPIN
MI2755570Medicaid