Martin, Lilla Gayle

Martin, Lilla Gayle is an sole proprietor health care provider with primary practice located at 1893 Kingsley Ave Suite B, Orange Park FL 32073-4491. She recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as her primary health care specialty. Martin, Lilla Gayle can be contacted via phone (904) 272-6955.

Contact Information

Primary practice address
1893 Kingsley Ave Suite B Orange Park FL 32073-4491
Fax: (904) 272-5001
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X ME0030921 Florida

Profile Details

NPI number 1275516999
LBN Legal business name Martin, Lilla Gayle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 28th, 2005
Last updated Apr 27th, 2010 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275516999 NPPES
Florida MEDICAID 065902900

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