Provider Demographics
NPI:1124248992
Name:EMANUEL MARTINEZ, MD AND ASSOCIATES, PA
Entity type:Organization
Organization Name:EMANUEL MARTINEZ, MD AND ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-940-2200
Mailing Address - Street 1:315 W TOWN PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3104
Mailing Address - Country:US
Mailing Address - Phone:904-940-2200
Mailing Address - Fax:904-940-2201
Practice Address - Street 1:1555 KINGSLEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4560
Practice Address - Country:US
Practice Address - Phone:904-278-4999
Practice Address - Fax:904-278-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8366101YM0800X
FLSW9531041C0700X
FLARNP9181473363LF0000X, 363LP0808X
FLARNP9222756363LP0808X
FLARNP9208000364SP0808X
FLME687582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8704Medicare ID - Type UnspecifiedMEDICARE GROUP ID
FL27411DMedicare PIN
FLG10509Medicare UPIN
FL78953ZMedicare PIN