Martin Inocentes Vicente

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

4881 Sugar Maple Dr
Wpafb, OH 45433

Phone

(937) 257-4023

NPI assigned

Apr 14, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546992000000",
    "number": "1801215256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 MAGNOLIA CIR",
            "address_2": "TYNDALL AFB 325TH MDG/SGOF",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324035604",
            "telephone_number": "850-283-7978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "45433",
            "telephone_number": "937-257-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICENTE",
        "first_name": "MARTIN",
        "middle_name": "INOCENTES",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-14",
        "last_updated": "2019-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David S Tubman, PSY.D., ABPP
• Mason Robert Tyler, DO
• Aiesha M Vaichus, PA
• Meagan B Verbillion, D.O.
• Cirrus Renae Micah Verity, MD
• Kristin Vogt, MD
• Lynda K Vu, M.D.
• Richard Adam Waggoner, PHYSICIAN ASSISTANT
• James Allen Wainright
• Jill Watson, DDS

• Medical Physician Assistant in Wpafb, OH
• Providers in Wpafb, OH by specialty
• Medical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.