Provider Demographics
NPI:1265879845
Name:MARTIN, TY H JAMES
Entity type:Individual
Prefix:
First Name:TY
Middle Name:H JAMES
Last Name:MARTIN
Suffix:
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 1:4735 NORTH THANKSGIVING WAY
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1547
Mailing Address - Country:US
Mailing Address - Phone:801-885-9595
Mailing Address - Fax:801-375-4241
Practice Address - Street 1:4735 NORTH THANKSGIVING WAY
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1547
Practice Address - Country:US
Practice Address - Phone:801-885-9595
Practice Address - Fax:801-375-4241
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker