Provider Demographics
NPI: | 1376820035 |
---|---|
Name: | JOHN V MARTIN MD LTD |
Entity Type: | Organization |
Organization Name: | JOHN V MARTIN MD LTD |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | V |
Authorized Official - Last Name: | MARTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 702-255-2022 |
Mailing Address - Street 1: | 2050 MARINER DR |
Mailing Address - Street 2: | SUITE 120 |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89128-6656 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-255-2022 |
Mailing Address - Fax: | 702-255-8810 |
Practice Address - Street 1: | 2050 MARINER DR |
Practice Address - Street 2: | SUITE 120 |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89128-6656 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-255-2022 |
Practice Address - Fax: | 702-255-8810 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-11-09 |
Last Update Date: | 2011-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NV | 7520 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |