Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | OS13854 | FL |
NPI | 1043654775 |
---|---|
Provider Name | Dr. Jose Antonio Martinez JR. |
First Address | Gotha, FL 34734-0645 |
Second Address | Ocoee, FL 34761-4547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FM6109208 | DEA (01) | FL |