Provider Demographics
NPI:1821046707
Name:MARTIN, JANET ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ROSE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24654 N LAKE PLEASANT PKWY STE 103-414
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1359
Mailing Address - Country:US
Mailing Address - Phone:866-614-8555
Mailing Address - Fax:
Practice Address - Street 1:24654 N LAKE PLEASANT PKWY STE 103-225
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1359
Practice Address - Country:US
Practice Address - Phone:866-614-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ336152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ965460Medicaid
AZAZ0784290OtherBLUE CROSS BLUE SHIELD
AZ965460Medicaid
AZH38155Medicare UPIN