Provider Demographics
NPI:1124115514
Name:MARTINEZ MEJIAS, EDWIN R (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:R
Last Name:MARTINEZ MEJIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:R
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:483 N SEMORAN BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-571-1056
Mailing Address - Fax:321-274-0322
Practice Address - Street 1:7806 LAKE UNDERHILL RD STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8232
Practice Address - Country:US
Practice Address - Phone:407-601-0888
Practice Address - Fax:407-601-0931
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3390207RC0000X
FLME95229207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038QROtherBCBS OF TEXAS
TX060070478OtherRAILROAD MEDICARE NUMBER
TX147494201Medicaid
TX8F4950OtherBCBS OF TEXAS
TX060070478OtherRAILROAD MEDICARE NUMBER
TX8F4950OtherBCBS OF TEXAS