Provider Demographics
NPI:1851033948
Name:MARTIN, JOHN WESLEY II
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLEY
Last Name:MARTIN
Suffix:II
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 1:156 LAMBERT DR APT 9
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-1188
Mailing Address - Country:US
Mailing Address - Phone:304-881-2843
Mailing Address - Fax:
Practice Address - Street 1:100 ANGUS E PEYTON DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1600
Practice Address - Country:US
Practice Address - Phone:304-746-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program