MEDICARE: DAVID JOHN MARTIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	A82729	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00051386	OTHER		RR MEDICARD

General Provider Information

NPI Number	:	1225036320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JOHN MARTIN M.D.

Provider Business Mailing Address
First Line	:	4415 SONOMA HWY
Second Line	:	SUITE A
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-7100
Country	:	US
Telephone Number	:	707-537-2070
Fax Number	:	707-537-9696

Provider Business Practice Location Address
First Line	:	4415 SONOMA HWY
Second Line	:	SUITE A
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-7100
Country	:	US
Telephone Number	:	707-537-2070
Fax Number	:	707-537-9696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/23/2007

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