Provider Demographics
NPI:1881817187
Name:DOCMARTIN'S PLLC
Entity Type:Organization
Organization Name:DOCMARTIN'S PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:636-916-9525
Mailing Address - Street 1:70 JUNGERMANN CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1622
Mailing Address - Country:US
Mailing Address - Phone:636-916-9525
Mailing Address - Fax:
Practice Address - Street 1:70 JUNGERMANN CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1622
Practice Address - Country:US
Practice Address - Phone:636-916-9525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107386261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG48535Medicare UPIN