Provider Demographics
NPI:1962528828
Name:MARTINEZ, JUAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:MARTINEZ
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:PO BOX 292474
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687-2474
Mailing Address - Country:US
Mailing Address - Phone:813-875-6520
Mailing Address - Fax:813-875-6416
Practice Address - Street 1:4600 N HABANA AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7166
Practice Address - Country:US
Practice Address - Phone:813-875-6520
Practice Address - Fax:813-875-6416
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034684207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30221Medicare ID - Type Unspecified
FLE14461Medicare UPIN