Provider Demographics
NPI:1578827275
Name:SHIRLEY, MARTHA JANE (DO,)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JANE
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:DO,
Other - Prefix:
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Mailing Address - Street 1:3630 GUION RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1616
Mailing Address - Country:US
Mailing Address - Phone:317-920-7280
Mailing Address - Fax:317-920-7284
Practice Address - Street 1:1011 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224-6977
Practice Address - Country:US
Practice Address - Phone:317-957-9050
Practice Address - Fax:317-957-9952
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11016762A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine