Individual
DR. JERRY DARREL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
129 MEDICAL PARK LANE, HUNTSVILLE, TX 77340
(936) 291-3459
(936) 294-0027
Mailing address
129 MEDICAL PARK LANE, HUNTSVILLE, TX 77340
(936) 291-3459
(936) 294-0027
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MDF1778
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00252T
BC
TX
05
—
114477604
—
TX
01
—
20044235
MCRR
TX
Enumeration date
04/11/2006
Last updated
03/04/2008
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