Provider Demographics
NPI:1952446080
Name:MARTIN, JEFFREY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 VEAZEY DR
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-1668
Mailing Address - Country:US
Mailing Address - Phone:919-764-2572
Mailing Address - Fax:919-764-2374
Practice Address - Street 1:NORTH CAROLINA DISABILITY DETERMINATION SERVICES
Practice Address - Street 2:3301 TERMINAL DR
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27602-0243
Practice Address - Country:US
Practice Address - Phone:919-212-3222
Practice Address - Fax:800-213-4916
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401264207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD57736Medicare UPIN