Provider Demographics
NPI:1679954192
Name:MARTIN, JOHN RHODES (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RHODES
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 1:395 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1434
Mailing Address - Country:US
Mailing Address - Phone:317-773-0760
Mailing Address - Fax:
Practice Address - Street 1:355 WESTFIELD RD STE 120
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1442
Practice Address - Country:US
Practice Address - Phone:317-776-8748
Practice Address - Fax:317-773-0314
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01090652A208600000X
IN11018327A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program