Provider Demographics
NPI:1083677926
Name:MARTIN, JEFFREY N (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:15620 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4168
Practice Address - Country:US
Practice Address - Phone:239-768-2057
Practice Address - Fax:239-768-2133
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO875207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1083677926OtherMEDICARE
ALG-73580OtherBC/BS OF ALABAMA