1326219627 NPI number — JOEL L MARTIN M D P A

Table of content: (NPI 1326219627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326219627 NPI number — JOEL L MARTIN M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOEL L MARTIN M D P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1326219627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3939 HOLLYWOOD BLVD
Provider Second Line Business Mailing Address:
STE 3A
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33021-6749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-961-7700
Provider Business Mailing Address Fax Number:
954-961-0092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3939 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
STE 3A
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021-6749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-961-7700
Provider Business Practice Location Address Fax Number:
954-961-0092
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-961-7700

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  ME0016209 , 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: 049413500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06844 . This is a "B/S" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 203294 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4068841 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 341998433 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1902072 . This is a "UNITED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0065443 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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