Individual
JERRY WAYNE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
338 GAY STREET, SUITE A, WASHINGTON, VA 22747-0269
(540) 675-3316
(540) 675-3692
Mailing address
PO BOX 269, WASHINGTON, VA 22747-0269
(540) 675-3316
(540) 675-3692
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101020616
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175551
ANTHEM BCBS
VA
Enumeration date
07/11/2006
Last updated
07/08/2007
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