Provider Demographics
NPI:1205933504
Name:MARTINEZ-CLARK, PEDRO O (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:O
Last Name:MARTINEZ-CLARK
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 1:5040 NW 7TH ST STE 750
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3490
Mailing Address - Country:US
Mailing Address - Phone:305-301-7169
Mailing Address - Fax:305-397-2986
Practice Address - Street 1:5040 NW 7TH STREET
Practice Address - Street 2:SUITE 750
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3490
Practice Address - Country:US
Practice Address - Phone:305-587-1752
Practice Address - Fax:305-397-2986
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97003207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2809745-00Medicaid