Individual
JAY W MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 W MARKET ST, SUITE 205, LIMA, OH 45805-2799
(419) 996-5780
(419) 996-5781
Mailing address
PO BOX 636930, CINCINNATI, OH 45263-0001
(513) 981-5015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-042566
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000029133
ANTHEM
OH
01
—
000000029134
ANTHEM
OH
05
—
0396530
—
OH
Enumeration date
01/09/2006
Last updated
12/22/2014
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