Individual
IAN MICHAEL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
12901 BRUCE B DOWNS BLVD # 41, TAMPA, FL 33612-4742
(813) 844-7412
(813) 974-8359
Mailing address
12901 BRUCE B DOWNS BLVD # 41, TAMPA, FL 33612-4742
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
DO.1717
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2013
Last updated
06/12/2019
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