Provider Demographics
NPI:1669612412
Name:MARTIN, JEFFREY DON (GFNP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:GFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18962
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-537-6869
Practice Address - Street 1:7003 WOODWAY DR
Practice Address - Street 2:SUITE 311
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6170
Practice Address - Country:US
Practice Address - Phone:254-537-6000
Practice Address - Fax:254-537-6001
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily