Provider Demographics
NPI:1801109640
Name:MARTIN, JEFFERY CHAD (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:CHAD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:410 N STATE OF FRANKLIN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6972
Mailing Address - Country:US
Mailing Address - Phone:423-431-2460
Mailing Address - Fax:423-431-2456
Practice Address - Street 1:410 N STATE OF FRANKLIN RD STE 140
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6972
Practice Address - Country:US
Practice Address - Phone:423-431-2460
Practice Address - Fax:423-431-2456
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY03837207X00000X, 207XX0801X
TN4080207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery