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General NPI Number Information
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NPI Number | 1801188933
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Entity Type | Individual
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Provider Name | JOSEPH SHANE MARTIN MD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2011
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-449-2766
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Fax |
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Provider Business Mailing Address
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Address Line | 856 PINE VALLEY RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7920
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Country | US
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Telephone | 252-864-3310
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1671953
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 79518
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24403
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 346136
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License Number State | LA
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13468-320
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License Number State | WI
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2012-01861
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License Number State | NC
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