Individual
JOSEPH E MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
205 SOUTH ST, FORT BRAGG, CA 95437-5540
(707) 964-1251
(707) 961-2722
Mailing address
205 SOUTH ST, FORT BRAGG, CA 95437-5540
(707) 964-1251
(707) 961-2722
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA15841
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EF732Z
PTAN
CA
05
—
FHC03967F
—
CA
Enumeration date
04/03/2007
Last updated
09/07/2011
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