Provider Demographics
NPI:1851475610
Name:MARTIN, RICHARD LEROY JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEROY
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25138 W. BLUE SKY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHITTMANN
Mailing Address - State:AZ
Mailing Address - Zip Code:85361
Mailing Address - Country:US
Mailing Address - Phone:740-312-3140
Mailing Address - Fax:
Practice Address - Street 1:3800 W RAY RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5940
Practice Address - Country:US
Practice Address - Phone:480-718-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000813213ES0103X
OH36003308M213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338992Medicaid
OH4091384Medicare PIN
OH2338992Medicaid