Martin, Gerald S
Martin, Gerald S is an individual health care provider with primary practice located at 404 S Lewis Ln , Carbondale IL 62901-3547. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Martin, Gerald S can be contacted via phone (618) 519-9200.Contact Information
Primary practice address
404 S Lewis Ln
Carbondale IL 62901-3547
Phone: (618) 519-9200
Fax: (618) 549-1288
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 209015754 | Illinois |
Profile Details
| NPI number | 1770014748 |
|---|---|
| LBN Legal business name | Martin, Gerald S |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 22nd, 2017 |
| Last updated | Sep 26th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770014748 | NPPES |
| Illinois | Other | 214881 | MEDICARE GROUP PTAN |
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