MEDICARE: DR. JEFFERY L MARTIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	04-18249	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	021119	OTHER	KS	BCBS OF KS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699759860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY L MARTIN MD

Provider Business Mailing Address
First Line	:	737 N 1550 RD
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-9198
Country	:	US
Telephone Number	:	785-766-2158
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-3099
Country	:	US
Telephone Number	:	785-594-2512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	12/15/2011

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