Provider Demographics
NPI:1689141194
Name:MARTIN, HARRY JR
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-9769
Mailing Address - Country:US
Mailing Address - Phone:907-821-1748
Mailing Address - Fax:907-782-4505
Practice Address - Street 1:39 LAKE RD
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-9769
Practice Address - Country:US
Practice Address - Phone:907-821-1748
Practice Address - Fax:907-782-4505
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator