Provider Demographics
NPI:1548264518
Name:MARTINEZ, EMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:
Last Name:MARTINEZ
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 1:315 W TOWN PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3104
Mailing Address - Country:US
Mailing Address - Phone:904-940-2200
Mailing Address - Fax:904-940-2201
Practice Address - Street 1:315 W TOWN PL
Practice Address - Street 2:SUITE 3
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3104
Practice Address - Country:US
Practice Address - Phone:904-940-2200
Practice Address - Fax:904-940-2201
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL687582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27411OtherBCBS OF FLORIDA PROVIDER
FL27411OtherBCBS OF FLORIDA PROVIDER
FL260050882Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROVIDE
FL27411BMedicare ID - Type Unspecified