Provider Demographics
NPI:1124311014
Name:MARTINEZ, JACOB SALOMON (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:SALOMON
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 SEAGATE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1969
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:200 E RUSSELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2072
Practice Address - Country:US
Practice Address - Phone:517-424-3040
Practice Address - Fax:517-423-0432
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2016-08-23
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Provider Licenses
StateLicense IDTaxonomies
MI4301097527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM35150086Medicare PIN