Provider Demographics
NPI:1255389052
Name:MARTIN, LEONA MARIE (MD)
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:MARIE
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 1:1841 W 25TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6920
Mailing Address - Country:US
Mailing Address - Phone:928-726-8600
Mailing Address - Fax:928-726-8610
Practice Address - Street 1:1841 W 25TH ST
Practice Address - Street 2:STE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6920
Practice Address - Country:US
Practice Address - Phone:928-726-8600
Practice Address - Fax:928-726-8610
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21951173000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ154500002Medicaid
AZAZ0158190OtherBLUE CROSS BLUE SHIELD
AZ27462Medicare ID - Type Unspecified
AZ154500002Medicaid