MEDICARE: TRACEY L MARTIN MD

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	207Q00000X	Family Medicine Physician	27302	AZ

General Provider Information

NPI Number	:	1770589491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY L MARTIN MD

Provider Business Mailing Address
First Line	:	4515 S MCCLINTOCK DR
Second Line	:	STE 100
City	:	TEMPE
State	:	AZ
Zip	:	85282-7381
Country	:	US
Telephone Number	:	480-820-1133
Fax Number	:	480-820-9292

Provider Business Practice Location Address
First Line	:	4515 S MCCLINTOCK DR
Second Line	:	STE 100
City	:	TEMPE
State	:	AZ
Zip	:	85282-7381
Country	:	US
Telephone Number	:	480-820-1133
Fax Number	:	480-820-9292

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	02/11/2011

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Directions to “ TRACEY L MARTIN MD” Practice Location

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