Provider Demographics
NPI:1770741217
Name:MARTIN, RUSSELL RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:RICHARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1111 E SPRUCE AVE STE 431
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3330
Mailing Address - Country:US
Mailing Address - Phone:559-450-7449
Mailing Address - Fax:559-450-7470
Practice Address - Street 1:1510 E HERNDON AVE STE 210
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3333
Practice Address - Country:US
Practice Address - Phone:559-450-7200
Practice Address - Fax:559-450-7214
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2023-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA108122208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery