Provider Demographics
NPI:1053425173
Name:MARTIN, JEFFREY ALAN (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
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 1:1801 S 5TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2919
Mailing Address - Country:US
Mailing Address - Phone:956-540-2949
Mailing Address - Fax:956-229-6184
Practice Address - Street 1:1801 S 5TH ST STE 104
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2919
Practice Address - Country:US
Practice Address - Phone:956-540-2949
Practice Address - Fax:956-229-6184
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22004207X00000X
TXT2208207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053425173Medicaid
TX2A1204OtherPTAN
AZ42814503Medicaid
AZ42814503Medicaid