Individual
MARTIN GINO FERNANDEZ PRADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1070 N STONE ST, SUITE D, DELAND, FL 32720-0919
(386) 822-9410
(386) 469-0045
Mailing address
PO BOX 945385, ATLANTA, GA 30394-5385
(386) 822-9410
(386) 469-0045
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME78262
FL
207RG0100X
Gastroenterology Physician
Primary
ME78262
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269724600
—
FL
01
—
593256803
TAX ID
FL
Enumeration date
05/08/2006
Last updated
06/12/2023
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