Provider Demographics
NPI:1497841118
Name:MARTIN, JAMES JOHNSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHNSTON
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 1:2085 THOMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2085
Mailing Address - Country:US
Mailing Address - Phone:542-269-5333
Mailing Address - Fax:541-269-5609
Practice Address - Street 1:2085 THOMPSON ROAD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2085
Practice Address - Country:US
Practice Address - Phone:542-269-5333
Practice Address - Fax:541-269-5609
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMDO8614103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR121632Medicaid
ORR0000BHDHZMedicare ID - Type Unspecified
OR121632Medicaid