Provider Demographics
NPI:1295759652
Name:MARTINEZ, SUZANNE L (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:LORRAINE
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2021 PROFESSIONAL CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4461
Mailing Address - Country:US
Mailing Address - Phone:904-777-2667
Mailing Address - Fax:904-777-2069
Practice Address - Street 1:2021 PROFESSIONAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4461
Practice Address - Country:US
Practice Address - Phone:904-777-2667
Practice Address - Fax:904-777-2069
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49388207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065875901Medicaid
FL68573UMedicare PIN