Provider Demographics
NPI:1841261070
Name:ARGUELLO, MARTHA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:ARGUELLO
Suffix:
Gender:F
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 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:309 PALM COAST PKWY NE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3886
Practice Address - Country:US
Practice Address - Phone:386-445-7073
Practice Address - Fax:386-481-5009
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268853100Medicaid
FL81096OtherBCBS
FLP00798209OtherRAILROAD MEDICARE
FL1841261070OtherTRICARE
FL181261070OtherVHN
FLE7320YMedicare PIN