Provider Demographics
NPI:1255326278
Name:MARTIN, ROBBIE L (MD)
Entity type:Individual
Prefix:
First Name:ROBBIE
Middle Name:L
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 1:3336 N CAMINO LOS BRAZOS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-2817
Mailing Address - Country:US
Mailing Address - Phone:303-482-2723
Mailing Address - Fax:
Practice Address - Street 1:301 N SHARY RD
Practice Address - Street 2:LOT 133
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-8263
Practice Address - Country:US
Practice Address - Phone:303-482-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50953207R00000X
CO40319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12873039Medicaid
CO12873039Medicaid
461318Medicare ID - Type Unspecified