Provider Demographics
NPI:1720131998
Name:MARTINEZ, EDUARDO G (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:G
Last Name:MARTINEZ
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:PO BOX 3029
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013
Mailing Address - Country:US
Mailing Address - Phone:305-835-9090
Mailing Address - Fax:305-694-9850
Practice Address - Street 1:4051 EAST 8 AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-835-9090
Practice Address - Fax:305-694-9850
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0058696207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372855200Medicaid
E87060Medicare UPIN
18789Medicare ID - Type Unspecified