Provider Demographics
NPI:1619995867
Name:MARTIN, GREGORY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
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 1:1121 F ST
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-3028
Mailing Address - Country:US
Mailing Address - Phone:559-638-2210
Mailing Address - Fax:559-638-6970
Practice Address - Street 1:1121 F ST
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-3028
Practice Address - Country:US
Practice Address - Phone:559-638-2210
Practice Address - Fax:559-638-6970
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A528030Medicaid
CA00A528030Medicaid
CAF96144Medicare UPIN