Basic Information
| Provider Information | |||||||||
| NPI: | 1205933504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ-CLARK | ||||||||
| FirstName: | PEDRO | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5040 NW 7TH ST STE 750 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331263490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053017169 | ||||||||
| FaxNumber: | 3053972986 | ||||||||
| Practice Location | |||||||||
| Address1: | 5040 NW 7TH STREET | ||||||||
| Address2: | SUITE 750 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331263490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055871752 | ||||||||
| FaxNumber: | 3053972986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | ME97003 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 2809745-00 | 05 | FL | MEDICAID |