NPIMap

Organization Active NPI

Sandy Martin Dermatology LLC

Doing business as Martin Dermatology

  • Dermatology Physician
  • Fort Myers, FL
National Provider Identifier
1265856256
Registry record updated Aug 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME30746 Issued in FL
Legal business name
SANDY MARTIN DERMATOLOGY LLC
Doing business as
Martin Dermatology
Practice address
13641 Metropolis Ave
Ste 102
Fort Myers, FL 33912-4433
Phone
(239) 208-4408
Fax
(888) 990-1670
NPI assigned
Feb 11, 2014
Last updated
Aug 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sandy Martin, MDNPI 1316980824
Title
Chief Executive Manager
Phone
(239) 208-4408

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X ME30746 FL Primary

Addresses

Primary practice location

13641 Metropolis Ave
Ste 102
Fort Myers, FL 33912-4433

Mailing address

1090 Camelot Cir
Naples, FL 34119-1308
Phone (561) 706-5422

Other names 1

  • MARTIN DERMATOLOGY Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407110400000",
    "number": "1265856256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 CAMELOT CIR",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341191308",
            "telephone_number": "561-706-5422",
            "fax_number": "888-990-1670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13641 METROPOLIS AVE",
            "address_2": "STE 102",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124433",
            "telephone_number": "239-208-4408",
            "fax_number": "888-990-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDY MARTIN DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-11",
        "last_updated": "2014-08-04",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE MANAGER",
        "authorized_official_telephone_number": "239-208-4408",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME30746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARTIN DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.