Martin Alla
Individual provider Active NPI General Practice Physician · Orange Park, FL
NPI 1386263267 · NPPES record last updated May 11, 2022
Key facts
- NPI
- 1386263267
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- OS18774 (FL)
- Practice address
- 2001 Kingsley Ave
Orange Park, FL 32073-5156 - Phone
- (904) 639-2000
- Fax
- (904) 639-2015
- NPI assigned
- Apr 10, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260616002537 | FL | Order and Referring Only - Internal Medicine |
8022580539 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS18774 | FL | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS18774 | FL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Physician | 208D00000X | OS18774 | FL | Yes |
Addresses
Primary practice location
2001 Kingsley Ave
Orange Park, FL 32073-5156
Mailing address
2001 Kingsley Ave
Orange Park, FL 32073-5156
Other providers in Orange Park, FL
- Bachar Alkhalil
- All About You Chiropractic, PLLC
- All Embracing Home Care Southeast, LLC.
- All Florida Respiratory LLC
- All Kids Care of Orange Park, LLC
- Jared Allen
- William S Allen Jr.
- Allergy & Asthma Specialists of North Florida PA
- Lisa Alleyne
- Alleyzee, Inc.
All providers in Orange Park, FL · General Practice Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.