Sandy Martin Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME30746 Issued in FL

Legal business name

SANDY MARTIN DERMATOLOGY LLC

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

Organization subpart

No

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

Authorized official

Name

Dr. Sandy Martin, MD

Title

Chief Executive Manager

Phone

(239) 208-4408

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• MARTIN DERMATOLOGY Doing business as

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "HS963A",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN FOR SANDY MARTIN MD",
            "identifier": "93792T",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARTIN DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Dermatology Physician in Florida

• 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.