Provider Demographics
NPI:1568769180
Name:HALLAM, MARTIN JOEL (DO)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOEL
Last Name:HALLAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:132-860-0338
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:5985 SILVER FALLS RUN STE 100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-1291
Practice Address - Country:US
Practice Address - Phone:941-202-2055
Practice Address - Fax:877-550-1635
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2024-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02005234A207VX0000X
FLOS13171207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics