MEDICARE: DR. CHRIS JOHN MARTIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MOR6J89	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114910817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS JOHN MARTIN M.D.

Provider Business Mailing Address
First Line	:	1601 E BROADWAY
Second Line	:	#200
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8020
Country	:	US
Telephone Number	:	573-441-2330
Fax Number	:	573-875-1359

Provider Business Practice Location Address
First Line	:	1601 E BROADWAY
Second Line	:	#200
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8020
Country	:	US
Telephone Number	:	573-441-2330
Fax Number	:	573-875-1359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	02/25/2010

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