MEDICARE: JOHN V MARTIN MD LTD

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	7520	NV

General Provider Information

NPI Number	:	1376820035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN V MARTIN MD LTD

Provider Business Mailing Address
First Line	:	2050 MARINER DR
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6656
Country	:	US
Telephone Number	:	702-255-2022
Fax Number	:	702-255-8810

Provider Business Practice Location Address
First Line	:	2050 MARINER DR
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6656
Country	:	US
Telephone Number	:	702-255-2022
Fax Number	:	702-255-8810

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	JOHN V MARTIN
Credential	:	MD
Telephone Number	:	702-255-2022

Provider Enumeration Date	:	11/09/2011
Last Update Date	:	11/09/2011

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