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Individual

JASON L MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1301 W 38TH ST, #205, AUSTIN, TX 78705-1011
(512) 324-1864
(512) 419-9016
Mailing address
PO BOX 26726, AUSTIN, TX 78755-0726
(512) 231-5506
(512) 406-6216

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
BP1-0028949
TX
207R00000X
Internal Medicine Physician
Primary
N7140
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
216275201
TX
05
216275202
TX
05
216275203
TX
01
4651577615
MYUTMB 4651577615
Enumeration date
08/05/2007
Last updated
10/30/2013
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