Provider Demographics
NPI:1427124114
Name:ARRISUENO, MARTIN ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:ALBERTO
Last Name:ARRISUENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 LAMPLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3019
Mailing Address - Country:US
Mailing Address - Phone:757-618-2239
Mailing Address - Fax:
Practice Address - Street 1:336 FORT PICKENS RD APT W109
Practice Address - Street 2:
Practice Address - City:PENSACOLA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32561-2049
Practice Address - Country:US
Practice Address - Phone:202-257-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062744A208D00000X
GUM1911207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice