Provider Demographics
NPI:1942352810
Name:MILNE, MARTIN J (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:MILNE
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25400 US HIGHWAY 19 N STE 201
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2144
Mailing Address - Country:US
Mailing Address - Phone:727-669-6411
Mailing Address - Fax:727-669-8231
Practice Address - Street 1:25400 US HIGHWAY 19 N STE 201
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2144
Practice Address - Country:US
Practice Address - Phone:727-669-6411
Practice Address - Fax:727-669-8231
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076664204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51798Medicare UPIN
FL49462AMedicare ID - Type Unspecified