Individual
DALE L. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1040 GULF BREEZE PKWY, GULF BREEZE, FL 32561-7809
(850) 916-8700
Mailing address
7178 BLUE JACK DR, NAVARRE, FL 32566-7304
(601) 447-1705
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11009121
FL
367500000X
Certified Registered Nurse Anesthetist
R787462
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03280005
—
MS
01
—
302I438792
MEDICARE PTAN
MS
01
—
3481631
UNITED HEALTHCARE
MS
01
—
4017520
CIGNA
MS
01
—
9060979
AETNA
MS
01
—
P01109800
RAILROAD MEDICARE
MS
Enumeration date
05/21/2012
Last updated
10/05/2024
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