MEDICARE: DR. JEFFERY MERLE MARTIN M.D.

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	2080N0001X	Neonatal-Perinatal Medicine Physician	28341	AZ

General Provider Information

NPI Number	:	1811949563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY MERLE MARTIN M.D.

Provider Business Mailing Address
First Line	:	37 W SIERRA VISTA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1200
Country	:	US
Telephone Number	:	602-957-8767
Fax Number	:	602-265-5489

Provider Business Practice Location Address
First Line	:	901 E WILLETTA ST
Second Line	:	ROOM 2503
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2727
Country	:	US
Telephone Number	:	602-239-5166
Fax Number	:	602-239-2307

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/09/2017

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