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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