Provider Demographics
NPI:1598853939
Name:MARTIN, JOHN STUART (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STUART
Last Name:MARTIN
Suffix:
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 1:4655 N COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2497
Mailing Address - Country:US
Mailing Address - Phone:520-459-3012
Mailing Address - Fax:520-459-3207
Practice Address - Street 1:1107 E BELL RD STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2692
Practice Address - Country:US
Practice Address - Phone:602-567-4800
Practice Address - Fax:602-567-9939
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00652207R00000X
SC32483207R00000X
AZ28549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28549OtherMEDICAL LICENSE
AZ28549OtherMEDICAL LICENSE