Provider Demographics
NPI:1417954298
Name:MARTENSSON, JOHANNES KARL (MD)
Entity type:Individual
Prefix:
First Name:JOHANNES
Middle Name:KARL
Last Name:MARTENSSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3653 E FOREST DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-0787
Mailing Address - Country:US
Mailing Address - Phone:352-344-8080
Mailing Address - Fax:352-344-0631
Practice Address - Street 1:3653 E FOREST DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-0787
Practice Address - Country:US
Practice Address - Phone:352-344-8080
Practice Address - Fax:352-344-0631
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71187207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203499OtherAVMED HEALTH PLANS
NY76981OtherVYTRA HEALTH PLANS
AKMD984FLOtherALASKA MEDICAID
FLP2957611OtherOXFORD HEALTH PLANS
CA2158646OtherFIRST HEALTH
FL2900908OtherUNITED HEALTH CARE
FL32728OtherBCBS OF FLORIDA
NY6015923OtherGROUP HEALTH INCORPORATED
FL0250317OtherCIGNA HEALTHCARE
NY6015923OtherGROUP HEALTH INCORPORATED
AKMD984FLOtherALASKA MEDICAID