Provider Demographics
NPI:1245585413
Name:MARTIN, DAVID WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:MARTIN
Suffix:JR
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 1:300 UTAH AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-6800
Mailing Address - Country:US
Mailing Address - Phone:650-873-1115
Mailing Address - Fax:650-873-1010
Practice Address - Street 1:300 UTAH AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-6800
Practice Address - Country:US
Practice Address - Phone:650-873-1115
Practice Address - Fax:650-873-1010
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine