Organization
MARTIN SURGICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRICK J MARTIN SR. MD (PRESIDENT)
(937) 439-4178
Entity
Organization
Contact information
Practice address
8940 KINGSRIDGE DRIVE, SUITE 105, DAYTON, OH 45458
(937) 439-4178
(937) 439-4740
Mailing address
8940 KINGSRIDGE DRIVE, SUITE 105, DAYTON, OH 45458
(937) 439-4178
(937) 439-4740
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000189411
ANTHEM
OH
05
—
0803330
—
OH
01
—
D60556
CHOICECARE
OH
Enumeration date
01/30/2006
Last updated
11/27/2007
Update your record
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