Individual
DR. JAKE LEE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 W VAN ASCHE LOOP, FAYETTEVILLE, AR 72703-4996
(479) 966-4491
(479) 966-4311
Mailing address
4301 W MARKHAM ST # 783, LITTLE ROCK, AR 72205-7101
(501) 686-8000
(501) 526-5148
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
E-17647
AR
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
E-17647
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2021
Last updated
06/03/2025
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