Provider Demographics
NPI:1043257728
Name:MARTIN, GREGORY M (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7593 BOYNTON BEACH BLVD
Mailing Address - Street 2:STE 280
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6154
Mailing Address - Country:US
Mailing Address - Phone:561-733-5888
Mailing Address - Fax:888-714-5190
Practice Address - Street 1:7593 BOYNTON BEACH BLVD
Practice Address - Street 2:STE 280
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6154
Practice Address - Country:US
Practice Address - Phone:561-733-5888
Practice Address - Fax:888-714-5190
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269402600Medicaid
FL269402600Medicaid
FL43311ZMedicare PIN