Provider Demographics
NPI:1275516999
Name:MARTIN, LILLA GAYLE (MD)
Entity type:Individual
Prefix:DR
First Name:LILLA
Middle Name:GAYLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1893 KINGSLEY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4491
Mailing Address - Country:US
Mailing Address - Phone:904-272-6955
Mailing Address - Fax:904-272-5001
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-9079
Practice Address - Fax:352-273-8889
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2025-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME30921207R00000X
FLME0030921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065902900Medicaid
FL065902900Medicaid