Provider Demographics
NPI:1295149466
Name:MIDNEY-MARTINEZ, ELIZABETH JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JOAN
Last Name:MIDNEY-MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MIDNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:863-674-5520
Mailing Address - Fax:863-674-5521
Practice Address - Street 1:930 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935
Practice Address - Country:US
Practice Address - Phone:863-674-5620
Practice Address - Fax:863-674-5521
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130379207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022025000Medicaid