Healthcare Provider Details

I. General information

NPI: 1811949563
Provider Name (Legal Business Name): JEFFERY MERLE MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E WILLETTA ST ROOM 2503
PHOENIX AZ
85006-2727
US

IV. Provider business mailing address

37 W SIERRA VISTA DR
PHOENIX AZ
85013-1200
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-5166
  • Fax: 602-239-2307
Mailing address:
  • Phone: 602-957-8767
  • Fax: 602-265-5489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number28341
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: