Provider Demographics
NPI:1700869740
Name:MARTIN, JAMEL ALPHONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMEL
Middle Name:ALPHONSO
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 1:8415 GOODWOOD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7851
Mailing Address - Country:US
Mailing Address - Phone:225-925-9797
Mailing Address - Fax:225-925-9787
Practice Address - Street 1:8415 GOODWOOD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7851
Practice Address - Country:US
Practice Address - Phone:225-925-9797
Practice Address - Fax:225-925-9787
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.024319208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1570176Medicaid
LA4N482D279Medicare PIN
LA1570176Medicaid
LA248327YJA2Medicare PIN