Provider Demographics
NPI:1013192798
Name:MARTINEZ, ALFONSO E (MD)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALFONSO
Other - Middle Name:ENRIQUE
Other - Last Name:MARTINEZ IRIZARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34421-0968
Mailing Address - Country:US
Mailing Address - Phone:352-789-5047
Mailing Address - Fax:352-574-6424
Practice Address - Street 1:7535 SW 62ND CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-5596
Practice Address - Country:US
Practice Address - Phone:352-789-5047
Practice Address - Fax:352-574-6424
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16987208D00000X
FLACN571208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016481000Medicaid