Individual
LAURA SUSAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 CAPITAL OAKS DR, TALLAHASSEE, FL 32308-4513
(850) 431-4041
(850) 431-4471
Mailing address
3333 CAPITAL OAKS DR, TALLAHASSEE, FL 32308-4513
(850) 431-7021
(850) 431-6975
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
ME43734
FL
208800000X
Urology Physician
ME43734
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102212446A
MEDICAID
GA
05
—
102212446A
—
GA
05
—
278957400
—
FL
Enumeration date
06/07/2006
Last updated
01/10/2017
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