Healthcare Provider Details

I. General information

NPI: 1063485795
Provider Name (Legal Business Name): JEFFREY DAVID MARTENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MAIN ST
YARMOUTH PORT MA
02675-2000
US

IV. Provider business mailing address

714 MAIN ST
YARMOUTH PORT MA
02675-2000
US

V. Phone/Fax

Practice location:
  • Phone: 508-362-1600
  • Fax: 508-362-5957
Mailing address:
  • Phone: 508-362-1600
  • Fax: 508-362-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number234351
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: