Individual
JERRY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65212-0001
(573) 882-2568
(573) 882-2226
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
RN307552
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
070444
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000325469
ANTHEM BCBS
OH
05
—
2442771
—
OH
05
—
912787918
—
MO
Enumeration date
08/24/2005
Last updated
05/10/2019
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