Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ACN1077 | FL |
NPI | 1023616430 |
---|---|
Provider Name | Dr. Danny Martinez |
First Address | Tallahassee, FL 32399-6548 |
Second Address | Tallahassee, FL 32399-6548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2020 |
Last Update Date | 16/10/2020 |