MR. DERRICK J MARTIN SR. (NPI# 1104980812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104980812 |
Entity Type | Individual |
Full Name | MR. DERRICK J MARTIN SR. |
Credential | MD |
Practice Address |
3003 S Florida Ave Ste 101 Lakeland FL 33803-4050 |
Mailing Address |
3810 Northdale Blvd Ste 150 Tampa FL 33624-1871 |
Practice Telephone | 8009916117 |
Practice Fax Number | 8888128191 |
Mailing Telephone | 8009916117 |
Mailing Fax Number | 8888128191 |
Enumeration Date | 2006-12-20 |
Last Update Date | 2020-04-15 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 208600000X | Surgery | MD205035 | LA | Allopathic & Osteopathic Physicians |
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
ME100133 | FL | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
LA | CHOICECARE | SDW70 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457875932 | Derrick Francis Martin | Counselor | 1601 Nantucket Dr, Mansfield, OH 44904-2147 | 2017-07-27 |
1831799972 | Derrick Martin Jr. | Rehabilitation Counselor | 306 Spruce Ave, South San Francisco, CA 94080-2741 | 2020-10-28 |
1417576208 | Derrick Martin | Student in an Organized Health Care Education/Training Program | 1313 E Herndon Ave, Fresno, CA 93720-3306 | 2020-04-11 |
1396031209 | Derrick E Martin Sr. | Counselor | 55 Ne Grand Ave, Portland, OR 97232 | 2011-06-20 |
1225154867 | Derrick A Martin | Physical Therapist | 7501 Greenway Center Dr, Suite 800, Greenbelt, MD 20770-3514 | 2007-03-22 |
Street Address |
3003 S FLORIDA AVE STE 101 |
City | LAKELAND |
State | FL |
Zip Code | 33803-4050 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1861964819 | Steven P Agelidis | Counselor | 2020 S. Florida Ave, Suite 207, Lakeland, FL 33803 | 2018-12-31 |
1902316201 | Kesara Mai Ngam | Massage Therapist | 117 West Oak Drive, Lakeland, FL 33803 | 2017-10-02 |
1396260618 | Suncoast Behavioral Solutions, LLC | Behavioral Analyst | 1920 E Edgewood Dr Apt A8, Lakeland, FL 33803 | 2017-08-08 |
1316484413 | Daniel Jacob Stahl | Behavior Technician | 145 East Edgewood Drive, Lakeland, FL 33803 | 2017-01-26 |
1780037002 | Shelley Stettinius | Behavioral Analyst | 145 East Edgewood Dr, Lakeland, FL 33803 | 2016-07-21 |
1396106654 | Highlands Occupational Therapy, Inc | Occupational Therapist | 2000 East Edgewood Drive, Suite 114, Lakeland, FL 33803 | 2016-03-15 |
1003289570 | Jayna Dinsmore | Physical Therapy Assistant | 321 Imperial Blvd, D38, Lakeland, FL 33803 | 2015-11-05 |
1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
1710316336 | Trinity Endodontics | Health Maintenance Organization | 1602 S. Florida Ave, Ste #1, Lakeland, FL 33803 | 2013-11-04 |
Find all providers in zip 33803 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528363041 | Rapha Vascular Specialists Inc. | Surgery | 1619 Harden Blvd, Lakeland, FL 33803-1826 | 2011-01-13 |
1689196248 | Vein & Vascular Experts, Pllc | Surgery | 5907 Hillside Heights Dr., Lakeland, FL 33812 | 2017-07-14 |
1558775874 | Tushar Champaklal Barot | Surgery | 1305 Lakeland Hills Blvd, Lakeland, FL 33805-4542 | 2014-06-14 |
1548526155 | Vascular Specialists of Lakeland, LLC | Surgery | 2125 Crystal Grove Dr, Lakeland, FL 33801-6875 | 2012-04-09 |
1811216732 | Ritu Aparajita | Surgery | 2125 Crystal Grove Dr, Lakeland, FL 33801-6875 | 2010-05-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104394857 | George Scott Hall Sr. | Surgery | 9 Marsh Creek Rd, Fernandina Beach, FL 32034-6413 | 2018-11-09 |
1316413115 | Fox Vascular Experts, LLC | Surgery | 2699 Stirling Rd Ste A301302, Fort Lauderdale, FL 33312-6517 | 2018-10-18 |
1114417508 | Vascular Center of Naples Inc. | Surgery | 5490 Bryson Dr Ste 201, Naples, FL 34109 | 2018-05-11 |
1598267593 | Joseph D Stillword, Md | Surgery | 800 Zeagler Dr Ste 320, Palatka, FL 32177-3827 | 2018-03-06 |
1386157006 | Beatriz Lam | Surgery | 2001 West 68 St, Cvicu, Hialeah, FL 33016 | 2017-11-16 |
1811421092 | Sunrise Vascular Center | Surgery | 8555 Nw 165th Ter, Miami Lakes, FL 33016-6138 | 2017-04-14 |
1962891838 | Global Trauma Systems, Inc | Surgery | 126 Se Mira Lavella, Port Saint Lucie, FL 34984-6615 | 2015-01-15 |
1184013450 | Vas-q-lar, Inc | Surgery | 6187 Nw 167th St, Suite H13, Hialeah, FL 33015-4340 | 2015-01-09 |
1396147138 | Usa Vein Clinics of Miami, LLC | Surgery | 1711 E Hallandale Beach Blvd Ste B, Hallandale Beach, FL 33009-4621 | 2014-09-24 |
1114336021 | Florida Vein Center, Inc | Surgery | 6050 53rd Ave E Unit A, Bradenton, FL 34203-9700 | 2014-08-05 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.