Individual
JACK L MARTIN
Active
Individual
JACK L MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
M9484
TX
207RC0000X
Cardiovascular Disease Physician
MD022890E
PA
207RI0011X
Interventional Cardiology Physician
Primary
129873-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8F8997
MEDICARE INDIVIDUAL PTAN
TX
Enumeration date
06/22/2005
Last updated
06/29/2022
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