Provider Demographics
NPI:1720037807
Name:MARTIN, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:950 S ARROYO PKWY
Mailing Address - Street 2:3RD FLOOR SUITE
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3930
Mailing Address - Country:US
Mailing Address - Phone:626-644-3283
Mailing Address - Fax:626-683-8331
Practice Address - Street 1:955 S ARROYO PKWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-644-3283
Practice Address - Fax:626-683-8331
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA62108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19268Medicare ID - Type Unspecified
CAH42818Medicare UPIN