Provider Demographics
NPI:1902804537
Name:MARTIN, JOHN PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
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:PO BOX 4908
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4908
Mailing Address - Country:US
Mailing Address - Phone:423-569-3762
Mailing Address - Fax:423-569-4909
Practice Address - Street 1:189 ANDREW ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6296
Practice Address - Country:US
Practice Address - Phone:423-569-3762
Practice Address - Fax:423-569-4909
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26733207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3094640Medicaid
KY64713324Medicaid
3094646Medicare PIN
E40998Medicare UPIN