Provider Demographics
NPI:1609885557
Name:MARTIN, PHILIP JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:MARTIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-6300
Mailing Address - Country:US
Mailing Address - Phone:813-471-0000
Mailing Address - Fax:
Practice Address - Street 1:9320 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-6300
Practice Address - Country:US
Practice Address - Phone:813-471-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257369207L00000X
NC2006-01111207L00000X
FLME144125207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117599209Medicaid