Provider Demographics
NPI:1265505622
Name:MARTIN, DANIEL JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JASON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:425 W 3RD AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1941
Mailing Address - Country:US
Mailing Address - Phone:229-312-7500
Mailing Address - Fax:229-312-7505
Practice Address - Street 1:425 W 3RD AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1941
Practice Address - Country:US
Practice Address - Phone:229-312-7500
Practice Address - Fax:229-312-7505
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA622552086S0129X, 208600000X
FLME 97064208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery