Individual
CHAYSE BROCKMAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
600 WILSON CREEK RD, LAWRENCEBURG, IN 47025-2751
(812) 532-2700
Mailing address
718 N MACOMB ST, MONROE, MI 48162-7815
(734) 240-1991
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02005646A
IN
207P00000X
Emergency Medicine Physician
04805
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0367858
—
OH
05
—
300030141
—
IN
05
—
7100672380
—
KY
Enumeration date
06/17/2015
Last updated
07/26/2021
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