Provider Demographics
NPI:1417491416
Name:MARTIN, ROBERT JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WESTBANK EXPY
Mailing Address - Street 2:STE. 550
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-4366
Mailing Address - Country:US
Mailing Address - Phone:504-247-9120
Mailing Address - Fax:504-247-9125
Practice Address - Street 1:1901 WESTBANK EXPY
Practice Address - Street 2:STE. 550
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4366
Practice Address - Country:US
Practice Address - Phone:504-247-9120
Practice Address - Fax:504-247-9125
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator