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General NPI Number Information
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NPI Number | 1003295239
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Entity Type | Individual
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Provider Name | JENNIFER LEE MARTIN D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1304 FAWCETT AVE STE 100
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City | TACOMA
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State | WA
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Zip | 98402-1900
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Country | US
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Telephone | 253-761-4200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 751461
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City | CHARLESTON
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State | SC
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Zip | 29425-3230
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Country | US
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Telephone | 843-792-6200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OT016512
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 39092
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 100138
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OP61602960
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License Number State | WA
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