Individual
MR. JEFFREY EDWARD MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
611 ZEAGLER DR, PALATKA, FL 32177-3810
(386) 328-5711
Mailing address
RR 1 BOX 475, IDABEL, OK 74745-9766
(580) 245-1182
(580) 208-3199
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9223834
FL
367500000X
Certified Registered Nurse Anesthetist
R0084629
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200075140A
—
OK
01
—
5Y758
BC/BS AR
AR
Enumeration date
08/10/2006
Last updated
08/26/2019
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