Provider Demographics
NPI:1487659843
Name:PERLMUTTER, MARTIN IRA (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:IRA
Last Name:PERLMUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12591 SORRENTO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8754
Mailing Address - Country:US
Mailing Address - Phone:850-497-0711
Mailing Address - Fax:850-497-0733
Practice Address - Street 1:12591 SORRENTO RD
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8754
Practice Address - Country:US
Practice Address - Phone:850-497-0711
Practice Address - Fax:850-497-0733
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD012579174400000X
FLME80465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB03902Medicare UPIN
FL51771SMedicare PIN
TN3326051Medicare PIN