1417954298 NPI number — JOHANNES KARL MARTENSSON M.D.

Table of content: JOHANNES KARL MARTENSSON M.D. (NPI 1417954298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417954298 NPI number — JOHANNES KARL MARTENSSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTENSSON
Provider First Name:
JOHANNES
Provider Middle Name:
KARL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417954298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3653 E FOREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INVERNESS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34453-0787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-344-8080
Provider Business Mailing Address Fax Number:
352-344-0631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3653 E FOREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INVERNESS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34453-0787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-344-8080
Provider Business Practice Location Address Fax Number:
352-344-0631
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME71187 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 203499 . This is a "AVMED HEALTH PLANS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 76981 . This is a "VYTRA HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MD984FL . This is a "ALASKA MEDICAID" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: P2957611 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2158646 . This is a "FIRST HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2900908 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 32728 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6015923 . This is a "GROUP HEALTH INCORPORATED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0250317 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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