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GERALYN MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
4510 FREDERICK AVE, SAINT JOSEPH, MO 64506-3238
(816) 364-9992
Mailing address
11399 170TH ST, VALLEY FALLS, KS 66088-4094

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
54483
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
54483
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
104325356000
COMMUNITY HEALTH PLAN
MO
01
146035
BLUE CROSS BLUE SHIELD KANSAS
KS
05
200536930A
KS
01
39351017
BLUE CROSS BLUE SHIELD KANSAS CITY
MO
01
8167
PREFERRED HEALTH SYSTEMS
KS
05
917024705
MO
01
P00455330
RAILROAD MEDICARE
KS
Enumeration date
06/13/2006
Last updated
10/22/2008
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