Provider Demographics
NPI:1457392136
Name:ST MARTIN, DACELIN (MD)
Entity type:Individual
Prefix:DR
First Name:DACELIN
Middle Name:
Last Name:ST MARTIN
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:PO BOX 2066
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-2066
Mailing Address - Country:US
Mailing Address - Phone:352-527-6888
Mailing Address - Fax:352-527-8818
Practice Address - Street 1:1990 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9792
Practice Address - Country:US
Practice Address - Phone:352-527-6888
Practice Address - Fax:352-527-8818
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90844207RS0012X, 208000000X, 2080S0012X, 207R00000X
TNMD0000059707207RS0012X
MEMD23213207RS0012X
VA0101268192207RS0012X
MA205680207RS0012X
IAMD-46944207RS0012X
IL036.151724207RS0012X
NY300985207RS0012X
UT11463402-1205207RS0012X
OH35.137194207RS0012X
CAC167271207RS0012X
IN01082741A207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269996600Medicaid
FLH38634Medicare UPIN
FL269996600Medicaid