Provider Demographics
NPI:1326056409
Name:MARTIN, MELISSA (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4419 E VERMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1740
Mailing Address - Country:US
Mailing Address - Phone:602-952-1716
Mailing Address - Fax:602-952-1916
Practice Address - Street 1:4419 E VERMONT AVE N
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-1740
Practice Address - Country:US
Practice Address - Phone:602-952-1716
Practice Address - Fax:602-952-1916
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology