Provider Demographics
NPI:1629115100
Name:MARTINEZ, LUIS GERARDO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GERARDO
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 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:3260 MURRELL RD STE 102
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4569
Practice Address - Country:US
Practice Address - Phone:321-632-8092
Practice Address - Fax:321-632-7520
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023166800Medicaid
FLME 97578OtherMEDICAL LICENSE
FLME 97578OtherMEDICAL LICENSE
FM278674500Medicaid