Organization
ISLAND COAST DERMATOLOGY, PA
Active
Organization
ISLAND COAST DERMATOLOGY, PA
Active
Other names
Island Coast Dermatology, PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY N MARTIN D.O. (SOLE PROPRIETOR)
(239) 768-6100
Entity
Organization
Contact information
Practice address
7310 COLLEGE PKWY, FORT MYERS, FL 33907-5503
(239) 768-6100
(239) 561-3763
Mailing address
7310 COLLEGE PKWY, FORT MYERS, FL 33907-5503
(239) 768-6100
(239) 561-3763
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS0006359
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070012707
RAILROAD MEDICARE
FL
01
—
44584
BCBS
FL
01
—
DE4849
RAILROAD GROUP #
FL
01
—
P00295648
PA'S RAILROAD MEDICARE #
FL
Enumeration date
01/15/2007
Last updated
06/24/2008
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