Individual
STEPHEN DOUGLAS MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGC, MPAS, PA-C
Contact information
Practice address
1401 N HIMES AVE, TAMPA, FL 33607
(813) 393-3725
Mailing address
1401 N HIMES AVE, TAMPA, FL 33607
(813) 393-3725
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 9101220
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9101220
PA LICENSE NUMBER
FL
01
—
U6812Z
SUPPLIER ID
FL
Enumeration date
06/06/2006
Last updated
07/01/2010
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