Provider Demographics
NPI:1265585640
Name:MARTIN, JAMES H (IDC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:MARTIN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 SHIELDS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2926
Mailing Address - Country:US
Mailing Address - Phone:858-336-1314
Mailing Address - Fax:
Practice Address - Street 1:2650 STOCKTON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6000
Practice Address - Country:US
Practice Address - Phone:619-524-1336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman