Individual
JASON ST MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 N 92ND ST, MILWAUKEE, WI 53226-3533
(414) 479-9400
(414) 529-1663
Mailing address
1000 N 92ND ST, MILWAUKEE, WI 53226-3533
(414) 479-9400
(414) 529-1663
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
S3564367026208
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019634
PUBLIC PASSENGER LICENSE
WI
Enumeration date
01/25/2008
Last updated
01/25/2008
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