Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | TRN12711 | FL |
NPI | 1003077058 |
---|---|
Provider Name | Dr. Jason Michael Martin |
First Address | Gainesville, FL 32606-9115 |
Second Address | Gainesville, FL 32610-0186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 23/06/2008 |