Individual
JOHN MICHAEL MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1330 R S KIMBALL, VANCLEAVE, MS 39565
(228) 826-4600
Mailing address
PO BOX 5386, VANCLEAVE, MS 39565-5386
(228) 826-4600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R851501
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126136
—
MS
Enumeration date
12/21/2006
Last updated
07/09/2007
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