Provider Demographics
NPI:1942254826
Name:MARTINEZ, LAZARO ROMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:ROMAN
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 SW 152ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2663
Mailing Address - Country:US
Mailing Address - Phone:305-225-0409
Mailing Address - Fax:305-551-9160
Practice Address - Street 1:1790 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2418
Practice Address - Country:US
Practice Address - Phone:305-567-9160
Practice Address - Fax:305-567-0792
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87557207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH93915Medicare UPIN
FL81375YMedicare ID - Type Unspecified