Healthcare Provider Details

I. General information

NPI: 1316201940
Provider Name (Legal Business Name): GREGORY MARTENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV SURG TRANSPLANT
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-9889
  • Fax: 314-361-4197
Mailing address:
  • Phone: 314-747-9889
  • Fax: 314-361-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2021016714
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: