Organization
SANDY MARTIN DERMATOLOGY LLC
Active
Organization
SANDY MARTIN DERMATOLOGY LLC
Active
Other names
MARTIN DERMATOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDY MARTIN MD (CHIEF EXECUTIVE MANAGER)
(239) 208-4408
Entity
Organization
Contact information
Practice address
13641 METROPOLIS AVE, STE 102, FORT MYERS, FL 33912-4433
(239) 208-4408
(888) 990-1670
Mailing address
1090 CAMELOT CIR, NAPLES, FL 34119-1308
(561) 706-5422
(888) 990-1670
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME30746
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93792T
MEDICARE PTAN FOR SANDY MARTIN MD
FL
01
—
HS963A
MEDICARE PTAN
FL
Enumeration date
02/11/2014
Last updated
08/04/2014
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