Provider Demographics
NPI:1265464648
Name:MARTIN, TOMAS D (MD)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TOMAS
Other - Middle Name:DITTO
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0129
Mailing Address - Country:US
Mailing Address - Phone:352-273-9730
Mailing Address - Fax:352-273-9737
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1211
Practice Address - Country:US
Practice Address - Phone:352-273-9730
Practice Address - Fax:352-273-9737
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54789208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041917600Medicaid
68486ZMedicare PIN
E58302Medicare UPIN