Healthcare Provider Details

I. General information

NPI: 1801862438
Provider Name (Legal Business Name): JOSEPH JOHN MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CTR 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-3202
US

IV. Provider business mailing address

34800 BOB WILSON DR NAVAL MEDICAL CTR
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7301
  • Fax:
Mailing address:
  • Phone: 619-532-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA063488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: