Healthcare Provider Details

I. General information

NPI: 1437026317
Provider Name (Legal Business Name): DONALD MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N, BLDG 1300
APO AA
89081
US

IV. Provider business mailing address

4700 LAS VEGAS BLVD N, BLDG 1300
APO AA
89081
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-3100
  • Fax:
Mailing address:
  • Phone: 702-653-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: