Individual
DR. BENNY JOE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
400 CRAVEN RD, SAN MARCOS, CA 92078-4201
(800) 290-5000
Mailing address
400 CRAVEN RD, SAN MARCOS, CA 92078-4201
(800) 290-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A12203
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114292
—
IL
01
—
06032182
BLUE CROSS BLUE SHIELD
IL
05
—
100256740D
—
OK
Enumeration date
07/08/2005
Last updated
02/23/2015
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