Provider Demographics
NPI:1790002079
Name:JENNIFER A MARTIN MD PLLC
Entity type:Organization
Organization Name:JENNIFER A MARTIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-689-2230
Mailing Address - Street 1:2315 MAYFAIR DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4557
Mailing Address - Country:US
Mailing Address - Phone:270-689-2230
Mailing Address - Fax:
Practice Address - Street 1:2315 MAYFAIR DR
Practice Address - Street 2:SUITE 9
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4557
Practice Address - Country:US
Practice Address - Phone:270-689-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty