Individual
MR. DERRICK J MARTIN SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10770 SE 173RD ST, SUMMERFIELD, FL 34491-6851
(352) 425-7321
(352) 748-2700
Mailing address
10770 SE 173RD ST, SUMMERFIELD, FL 34491-6851
(352) 425-7321
(888) 812-8191
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME100133
FL
208600000X
Surgery Physician
MD205035
LA
2086S0129X
Vascular Surgery Physician
ME100133
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SDW70
CHOICECARE
LA
Enumeration date
12/20/2006
Last updated
09/21/2022
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