Provider Demographics
NPI:1285890558
Name:ARMANDO O MARTINEZ MD PA
Entity type:Organization
Organization Name:ARMANDO O MARTINEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:ONEL
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:321-459-1333
Mailing Address - Street 1:1395 N COURTENAY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4400
Mailing Address - Country:US
Mailing Address - Phone:321-459-1333
Mailing Address - Fax:321-453-0189
Practice Address - Street 1:1395 N COURTENAY PKWY
Practice Address - Street 2:SUITE # 200
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4400
Practice Address - Country:US
Practice Address - Phone:321-459-1333
Practice Address - Fax:321-453-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056031600Medicaid
FL05340Medicare PIN
FLD84862Medicare UPIN