Charles Kevin Martin PA

NPI 1114101813 - Physician Assistant - 363A00000X

NPI Details
NPI 1114101813
Gender Male
Enumeration Date 12/18/2007
Last Updated 10/20/2010
Entity Type Individual
Active Over 8 years ago
Practice Location
5050 N CLINTON ST
FORT WAYNE IN, 46825-5822, US
Phone (260) 484-8551
Fax (260) 484-9603
Business Location
5050 N CLINTON ST
FORT WAYNE IN, 46825-5822, US
Phone (260) 484-8551
Fax (260) 484-9603
Toxanomy
Taxonomy Code 363A00000X
License State Indiana
License Number 10000978A
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According to our database, Charles Kevin Martin PA NPI is 1114101813, taxonomy code is 363A00000X and license number is 10000978A, license state is located at Indiana. Charles Kevin Martin PA physically located at 5050 N Clinton St, Fort Wayne IN, 46825-5822. NPI Number Charles Kevin Martin PA has the Individual type.

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1114101813 NPI number is provided on an as is basis without warranty of any kind. 1114101813 is maintained by the National Plan & Provider Enumeration System. The contents of Charles Kevin Martin PA are for informational purposes only.