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Individual
JACOB SAMUEL MARTIN
Active
Individual
JACOB SAMUEL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
72243
WI
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
Primary
72243
WI
207ZP0101X
Anatomic Pathology Physician
72243
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447781265
—
WI
Enumeration date
03/23/2017
Last updated
03/12/2024
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