Healthcare Provider Details

I. General information

NPI: 1619995867
Provider Name (Legal Business Name): GREGORY JOHN MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST
SAN FRANCISCO CA
94114-1010
US

IV. Provider business mailing address

601 VAN NESS AVE STE E3619
SAN FRANCISCO CA
94102-3200
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6000
  • Fax:
Mailing address:
  • Phone: 415-531-9047
  • Fax: 415-213-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA52803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: