Provider Demographics
NPI:1104104264
Name:MARTINEZ LOPEZ, OSCAR (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:MARTINEZ LOPEZ
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 1:1801 SE HILLMOOR DR STE C-207
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7574
Mailing Address - Country:US
Mailing Address - Phone:772-335-4234
Mailing Address - Fax:772-335-4236
Practice Address - Street 1:1801 SE HILLMOOR DR STE C-207
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7574
Practice Address - Country:US
Practice Address - Phone:772-335-4234
Practice Address - Fax:772-335-4236
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57018996207R00000X
FLME0119592208M00000X
FLME119592207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME119592OtherMEDICAL LICENSE