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Organization
VASCULAR CENTER OF ORLANDO, P.A.
Active
Organization
VASCULAR CENTER OF ORLANDO, P.A.
Active
Other names
Vascular Centers of Orlando
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL PRESTON MARTIN IV M.D. (OWNER)
(407) 244-8559
Entity
Organization
Contact information
Practice address
1200 EDGEWATER DR, ORLANDO, FL 32804-6314
(407) 244-8559
(407) 244-8560
Mailing address
1200 EDGEWATER DR, ORLANDO, FL 32804-6314
(407) 244-8559
(407) 244-8560
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME31846
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037049500
—
FL
01
—
060065287
CHAMPUS
FL
Enumeration date
07/28/2005
Last updated
10/10/2012
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