Provider Demographics
NPI:1679681753
Name:MARTIN, JULIE H (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:H
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5126
Mailing Address - Country:US
Mailing Address - Phone:225-201-2000
Mailing Address - Fax:225-201-2110
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:STE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5126
Practice Address - Country:US
Practice Address - Phone:225-201-2000
Practice Address - Fax:225-201-2110
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025875207V00000X, 207V00000X
WI48306207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1043681Medicaid
WI34685100Medicaid
WI000738245Medicare ID - Type Unspecified
WI34685100Medicaid