Basic Information
| Provider Information | |||||||||
| NPI: | 1730831413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDRO MARTINEZ-CLARK MD PA | ||||||||
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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: | 8663979493 | ||||||||
| Practice Location | |||||||||
| Address1: | 9999 NE 2ND AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MIAMI SHORES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331382344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057541654 | ||||||||
| FaxNumber: | 8663979443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2022 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ-CLARK | ||||||||
| AuthorizedOfficialFirstName: | PEDRO | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3052495666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.