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General NPI Number Information
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NPI Number | 1104079862
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Entity Type | Individual
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Provider Name | JEFFREY BRIAN MARTIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1425 N RANDALL RD
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City | ELGIN
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State | IL
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Zip | 60123-2300
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Country | US
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Telephone | 847-742-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 12251 S 80TH AVE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1290
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Country | US
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Telephone | 708-923-4000
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Fax | 708-923-8848
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125-054163
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 125054163
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 101705
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101281968
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036133427
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License Number State | IL
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