Provider Demographics
NPI:1164085296
Name:MARTIN, JEFFREY (PROSTHETIC SPECAILIS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PROSTHETIC SPECAILIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8876 VINTAGE PARK DR # 1158876
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-5893
Mailing Address - Country:US
Mailing Address - Phone:713-992-2720
Mailing Address - Fax:
Practice Address - Street 1:8876 VINTAGE PARK DR # 1158876
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-5893
Practice Address - Country:US
Practice Address - Phone:713-992-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management