Basic Information
| Provider Information | |||||||||
| NPI: | 1033524459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 W COPELAND DR FL 2 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218417550 | ||||||||
| FaxNumber: | 3218418185 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 W COPELAND DR FL 2 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218417550 | ||||||||
| FaxNumber: | 3218418185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2014 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME150512 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 110492500 | 05 | FL | MEDICAID |