Provider Demographics
NPI:1821255621
Name:MARTIN, BRENDA ANN (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
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 1:10105 E VIA LINDA
Mailing Address - Street 2:STE 103-282
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5311
Mailing Address - Country:US
Mailing Address - Phone:480-767-0010
Mailing Address - Fax:480-767-0030
Practice Address - Street 1:9500 E IRONWOOD SQUARE DR STE 124
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-767-0010
Practice Address - Fax:480-767-0030
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00744207V00000X
AZ4036207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ370950Medicaid