Basic Information
| Provider Information | |||||||||
| NPI: | 1124311014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | SALOMON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SEAGATE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675851969 | ||||||||
| FaxNumber: | 4198247359 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E RUSSELL RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | TECUMSEH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492862072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174243040 | ||||||||
| FaxNumber: | 5174230432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2011 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301097527 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.