Individual
DR. REGINALD WILLIS MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
971 LAKELAND DR STE 211, JACKSON, MS 39216-4607
(601) 200-4350
(601) 200-4356
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MS 13610
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112817
—
MS
01
—
P01151405
RAILROAD MEDICARE
MS
Enumeration date
03/28/2007
Last updated
03/13/2014
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