1689867178 NPI number — DR. JEFFREY PETER MARTEL M.D.

Table of content: DR. JEFFREY PETER MARTEL M.D. (NPI 1689867178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689867178 NPI number — DR. JEFFREY PETER MARTEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTEL
Provider First Name:
JEFFREY
Provider Middle Name:
PETER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689867178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 E MISSOURI AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-1351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-262-8917
Provider Business Mailing Address Fax Number:
602-262-8890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 E MISSOURI AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012-1351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-262-8917
Provider Business Practice Location Address Fax Number:
602-262-8890
Provider Enumeration Date:
08/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD60215737 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 0116019814 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 53924 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 264117 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".