Provider Demographics
NPI:1679854830
Name:MARTIN, JOSEPH CROSBY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CROSBY
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 1:1158 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41011-5606
Mailing Address - Country:US
Mailing Address - Phone:859-292-8068
Mailing Address - Fax:859-577-5784
Practice Address - Street 1:1158 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:KY
Practice Address - Zip Code:41011-5606
Practice Address - Country:US
Practice Address - Phone:859-292-8068
Practice Address - Fax:859-261-7860
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24829208600000X
CO24961208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery