MARTIN, GREGORY BLAIN (MD)

Provider Demographics

• NPI: 1457529927
• Name: MARTIN, GREGORY BLAIN (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: GREGORY
• Middle Name: BLAIN
• Last Name: MARTIN
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 501 E HAMPDEN AVE
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80113-2702
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2008-02-18
• Last Update Date: 2024-03-29

Provider Licenses

State	License ID	Taxonomies
HI	MD18497	2085R0202X
CO	56120	2085R0202X
NE	28911	2085R0202X
CO	73301	390200000X
UT	7465134-1205	2085R0202X, 2085R0204X
KS	04-38620	2085R0202X
CO	DR.0056120	2085R0204X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0204X	Allopathic & Osteopathic Physicians	Radiology	Vascular & Interventional Radiology
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology
No	390200000X	Student, Health Care	Student in an Organized Health Care Education/Training Program

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KS	201127660A	Medicaid
UT	5033909	Other	AETNA HEALTHCARE
NM	72231033	Medicaid
UT	P01180703	Other	RAILROAD MEDICARE
AZ	091605	Medicaid
UT	1457529927	Other	EMI HEALTH
IA	1457529927	Medicaid
UT	107120143101	Other	SELECTHEALTH
UT	1137619	Other	DMBA
UT	1457529927	Other	MOLINA HEALTHCARE
UT	10000009363001	Other	BCBSU
UT	145450	Other	PEHP
UT	1457529927	Medicaid
MT	1457529927	Medicaid
WY	1457529927	Medicaid
OK	20062369A	Medicaid
CO	81700059	Medicaid
CO	462849ZLJ3	Medicare PIN
OK	20062369A	Medicaid
NE	P01638775	Medicare PIN
CO	462849YQPG	Medicare PIN
UT	P01180703	Other	RAILROAD MEDICARE
UT	1457529927	Other	EMI HEALTH
UT	1457529927	Medicaid
CO	462849YQ3L	Medicare PIN
CO	462849YQ33	Medicare PIN
HI	H107965	Medicare PIN
NM	72231033	Medicaid
KS	201127660A	Medicaid
HI	H107964	Medicare PIN
NE	NA2517074	Medicare PIN
KS	KA3249075	Medicare PIN