Provider Demographics
NPI:1215914593
Name:COETZEE, MARTHA M (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:M
Last Name:COETZEE
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 1:1012 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3369
Mailing Address - Country:US
Mailing Address - Phone:561-843-3775
Mailing Address - Fax:
Practice Address - Street 1:1004 W OAK ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-3369
Practice Address - Country:US
Practice Address - Phone:561-843-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.00127532084P0800X
FLME963162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001348580007Medicaid