Provider Demographics
NPI:1932604998
Name:JOSEPH, MARTIN ALEXANDER (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ALEXANDER
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W EUGIE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1258
Mailing Address - Country:US
Mailing Address - Phone:623-698-2949
Mailing Address - Fax:
Practice Address - Street 1:5601 W EUGIE AVE STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1258
Practice Address - Country:US
Practice Address - Phone:623-698-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ390200000X
AZ010797207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program