Provider Demographics
NPI:1912158940
Name:MARTIN, CLAUDE JR (RTR)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:RTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 CHASE LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40337-8979
Mailing Address - Country:US
Mailing Address - Phone:859-294-6185
Mailing Address - Fax:859-294-6184
Practice Address - Street 1:OLD HWY 11
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314-0737
Practice Address - Country:US
Practice Address - Phone:859-294-6185
Practice Address - Fax:859-294-6184
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY720223335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY86000338Medicaid
KY86000338Medicaid