Martin, Reginald Willis
Martin, Reginald Willis is an sole proprietor health care provider with primary practice located at 971 Lakeland Dr Ste 211 , Jackson MS 39216-4607. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Martin, Reginald Willis can be contacted via phone (601) 200-4350.Contact Information
Primary practice address
971 Lakeland Dr Ste 211
Jackson MS 39216-4607
Phone: (601) 200-4350
Fax: (601) 200-4356
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | MS 13610 | Mississippi |
Profile Details
| NPI number | 1679692396 |
|---|---|
| LBN Legal business name | Martin, Reginald Willis |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 28th, 2007 |
| Last updated | Mar 13th, 2014 - about 11 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 | 1679692396 | NPPES |
| Mississippi | Other | P01151405 | RAILROAD MEDICARE |
| Mississippi | MEDICAID | 00112817 | RAILROAD MEDICARE |
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