Provider Demographics
NPI:1376566562
Name:MARTIN, JOHN JOSEPH JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2912 S DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6902
Mailing Address - Country:US
Mailing Address - Phone:305-444-5950
Mailing Address - Fax:305-444-8670
Practice Address - Street 1:2912 S DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6902
Practice Address - Country:US
Practice Address - Phone:305-444-5950
Practice Address - Fax:305-444-8670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 47615208200000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058930600Medicaid
FL09861Medicare UPIN
FL058930600Medicaid