Provider Demographics
NPI:1336547199
Name:JOHN B MARTIN MD
Entity type:Organization
Organization Name:JOHN B MARTIN MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BARLOW
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:314-725-2618
Mailing Address - Street 1:312 N MERAMEC AVE APT 300
Mailing Address - Street 2:312 N MERAMEC #300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3774
Mailing Address - Country:US
Mailing Address - Phone:314-725-2618
Mailing Address - Fax:314-725-2618
Practice Address - Street 1:312 N MERAMEC AVE APT 300
Practice Address - Street 2:312 N MERAMEC #300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3774
Practice Address - Country:US
Practice Address - Phone:314-725-2618
Practice Address - Fax:314-725-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO26157261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26157Medicare UPIN
MO26157Medicare PIN