| Entity Name: | ROBERT MARTINEZ, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Nov 1979 (45 years ago) |
| Document Number: | 644001 |
| FEI/EIN Number | 591944553 |
| Address: | 402 WEST DR. MARTIN LUTHER KING BLVD., TAMPA, FL, 33603, US |
| Mail Address: | 402 W. DR. ML KING JR BLVD, TAMPA, FL, 33603, US |
| ZIP code: | 33603 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407164114 | 2010-09-15 | 2010-09-15 | 402 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL, 336033504, US | 402 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL, 336033504, US | |||||||||||||||||||||||||
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| Phone | +1 813-223-4444 |
| Fax | 8132299104 |
Authorized person
| Name | ROBERT MARTINEZ |
| Role | PRESIDENT/NEUROLOGIST |
| Phone | 8132234444 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME31847 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 037985900 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT MARTINEZ, MD, PA PROFIT SHARING PLAN | 2021 | 591944553 | 2023-06-30 | ROBERT MARTINEZ M.D., P.A. | 16 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 592025079 |
| Plan administrator’s name | PROFIT SHARING COMMITTEE FOR ROBERT MARTINEZ, MD, PA |
| Plan administrator’s address | 402 W. DR. MARTIN LUTHER KING BLVD., TAMPA, FL, 33603 |
| Administrator’s telephone number | 8132234444 |
Signature of
| Role | Plan administrator |
| Date | 2023-06-30 |
| Name of individual signing | ROBERT MARTINEZ |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 1979-11-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8132234444 |
| Plan sponsor’s address | 402 W. MARTIN LUTHER KING BLVD., TAMPA, FL, 33603 |
Plan administrator’s name and address
| Administrator’s EIN | 592025079 |
| Plan administrator’s name | PROFIT SHARING COMMITTEE FOR ROBERT MARTINEZ, MD, PA |
| Plan administrator’s address | 402 W. DR. MARTIN LUTHER KING BLVD., TAMPA, FL, 33603 |
| Administrator’s telephone number | 8132234444 |
Signature of
| Role | Plan administrator |
| Date | 2022-11-30 |
| Name of individual signing | ROBERT MARTINEZ |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MARTINEZ ROBERT M | Agent | 402 W. ML KING JR. BLVD, TAMPA, FL, 33603 |
| Name | Role | Address |
|---|---|---|
| Martinez Robert Dr. | President | 402 W. DR. ML KING, JR. BLVD, TAMPA, FL, 33603 |
| Name | Role | Address |
|---|---|---|
| Martinez Robert Dr. | Secretary | 402 W. DR. ML KING, JR. BLVD, TAMPA, FL, 33603 |
| Name | Role | Address |
|---|---|---|
| Martinez Robert Dr. | Director | 402 W. DR. ML KING, JR. BLVD, TAMPA, FL, 33603 |
| Name | Role | Address |
|---|---|---|
| Martinez Robert CDr. | Vice President | 402 WEST DR. MARTIN LUTHER KING BLVD., TAMPA, FL, 33603 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
