Back, Martin
Back, Martin is an individual health care provider with primary practice located at 12901 Bruce B Downs Blvd , Tampa FL 33612-4742. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as his primary health care specialty. Back, Martin can be contacted via phone (813) 259-0956.Contact Information
Primary practice address
12901 Bruce B Downs Blvd
Tampa FL 33612-4742
Phone: (813) 259-0956
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | ME71212 | Florida |
Profile Details
| NPI number | 1962414342 |
|---|---|
| LBN Legal business name | Back, Martin |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 13th, 2006 |
| Last updated | Feb 7th, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962414342 | NPPES |
| Florida | MEDICAID | 254458000 | |
| Florida | Other | 43628 |
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