Provider Demographics
NPI:1679885776
Name:MARTIN, DON JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:JORDAN
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 1:3329 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1063
Mailing Address - Country:US
Mailing Address - Phone:920-380-2715
Mailing Address - Fax:920-380-2755
Practice Address - Street 1:3329 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1063
Practice Address - Country:US
Practice Address - Phone:920-380-2715
Practice Address - Fax:920-380-2755
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61008-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine