Provider Demographics
NPI:1376521690
Name:MARTIN, JOSEPH G (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 53RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7564
Mailing Address - Country:US
Mailing Address - Phone:563-322-0971
Mailing Address - Fax:563-324-0615
Practice Address - Street 1:2300 53RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7564
Practice Address - Country:US
Practice Address - Phone:563-322-0971
Practice Address - Fax:563-324-0615
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29326207X00000X
IL036092379207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
19952OtherIA HEALTH SOLUTIONS
IA58113OtherWELLMARK
IAIA0146OtherJOHN DEERE FAMILY
IA57865OtherWELLMARK
200029094OtherRR MEDICARE
IA58102OtherWELLMARK
IAT81029OtherJOHN DEERE FAMILY
IA0110544Medicaid
IAIA0158OtherJOHN DEERE FAMILY
040798OtherHEALTH ALLIANCE
15537OtherMIDLANDS CHOICE
IL8121085OtherBCBS
IL8121085OtherBCBS
F81668Medicare UPIN