Provider Demographics
NPI:1194961144
Name:MARTIN, JOHN GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4456 NW 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1550
Mailing Address - Country:US
Mailing Address - Phone:954-753-9250
Mailing Address - Fax:
Practice Address - Street 1:4456 NW 100TH AVE
Practice Address - Street 2:203
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1550
Practice Address - Country:US
Practice Address - Phone:954-753-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0471872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry