Provider Demographics
NPI:1194060582
Name:MARTIN, WILMA JEAN (MD)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:JEAN
Last Name:MARTIN
Suffix:
Gender:F
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:P.O.BOX 300
Mailing Address - Street 2:PCS PHOSPHATE HWY 41N
Mailing Address - City:WHITE SPRINGS,
Mailing Address - State:FL
Mailing Address - Zip Code:32096
Mailing Address - Country:US
Mailing Address - Phone:386-397-8781
Mailing Address - Fax:386-397-8720
Practice Address - Street 1:HWY 41 NORTH
Practice Address - Street 2:PCS PHOSPHATE SWIFT CREEK
Practice Address - City:WHITE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32096
Practice Address - Country:US
Practice Address - Phone:386-397-8781
Practice Address - Fax:386-397-8720
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32862207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine