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
StateLicense IDTaxonomies
NV7520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty