Provider Demographics
NPI:1386632164
Name:MARTIN, JOHN ARTHUR (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ARTHUR
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:501 LAPEER AVE
Mailing Address - Street 2:HEALTH DELIVERY INC
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:3884 MONITOR RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9298
Practice Address - Country:US
Practice Address - Phone:989-671-2000
Practice Address - Fax:989-671-4000
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012014OtherMCLAREN HEALTH PLAN
MI260OtherCOMMUNITY CHOICE
146037OtherGREAT LAKES HEALTH PLAN
1012014OtherHEALTH ADVANTAGE PPO
381908328OtherTRICARE
MI080G310660OtherBLUE CROSS BLUE SHIELD MI
MI2832651OtherMOLINA HEALTH CARE
MI080G310660OtherBLUE CROSS BLUE SHIELD MI
1012014OtherMCLAREN HEALTH PLAN