Provider Demographics
NPI:1013002468
Name:MARTIN, DANIEL JAMES (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:MARTIN
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1907 W. MORRIS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813
Mailing Address - Country:US
Mailing Address - Phone:423-587-2707
Mailing Address - Fax:423-587-3224
Practice Address - Street 1:1907 W. MORRIS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-587-2707
Practice Address - Fax:423-587-3224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNPA746363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant