MEDICARE: DR. JUDSON F 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	207L00000X	Anesthesiology Physician	103080	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	:	1184629032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDSON F MARTIN M.D.

Provider Business Mailing Address
First Line	:	339 CONSORT DR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4439
Country	:	US
Telephone Number	:	636-386-9224
Fax Number	:	636-200-4243

Provider Business Practice Location Address
First Line	:	17050 BAXTER ROAD
Second Line	:	CHESTERFIELD SURGERY CENTER, LLC, SUITE 110
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005
Country	:	US
Telephone Number	:	636-537-0122
Fax Number	:	636-537-0480

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/27/2016

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