Doctor Name: | JERRY VANN MARTIN |
NPI Number: | 1013172733 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A23873 |
Business Practice Address: | 2500 Mowry Ave Suite 212 Fremont, CA - 945381605 |
Business Phone Number: | 5106086174 |
Business Fax Number: | 5107456435 |
Mailing Address: | 7079 Homewood Dr, OAKLAND |
State: | CA |
Postal Code: | 946111451 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/22/2008 |
NPI Last Update Date: | 02/03/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207PE0004X |
License Number: | A23873 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Emergency Medicine |
Taxonomy Specialization: | Emergency Medical Services |
Taxonomy Definition: | An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |