Individual
DR. DANIEL J MARTIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
621 S NEW BALLAS RD, 5015B, SAINT LOUIS, MO 63141-8232
(314) 567-5850
(314) 567-9169
Mailing address
621 S NEW BALLAS RD, 5015B, SAINT LOUIS, MO 63141-8232
(314) 567-5850
(314) 567-9169
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MDR1P08
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203179601
—
MO
Enumeration date
08/21/2006
Last updated
07/09/2007
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