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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 2 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770014748 NPPES
Illinois Other 214881 MEDICARE GROUP PTAN

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