Provider Demographics
NPI:1093711228
Name:MARTIN, JOHN BRUCE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRUCE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 AMICKS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9403
Mailing Address - Country:US
Mailing Address - Phone:803-397-3838
Mailing Address - Fax:
Practice Address - Street 1:TAYLOR AT MARION
Practice Address - Street 2:PALMETTO HEALTH BAPTIST
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220
Practice Address - Country:US
Practice Address - Phone:803-296-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN 3754367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered