Provider Demographics
NPI:1861710881
Name:JOHN J MARTIN JR MD,PA
Entity type:Organization
Organization Name:JOHN J MARTIN JR MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:305-444-5950
Mailing Address - Street 1:325 ALHAMBRA CIR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5003
Mailing Address - Country:US
Mailing Address - Phone:305-444-5950
Mailing Address - Fax:305-444-8670
Practice Address - Street 1:325 ALHAMBRA CIR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5003
Practice Address - Country:US
Practice Address - Phone:305-444-5950
Practice Address - Fax:305-444-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47615208200000X
FLME 47615207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty