Healthcare Provider Details

I. General information

NPI: 1952652141
Provider Name (Legal Business Name): THOMAS MICHAEL MARTIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W RAY RD STE 6&7
CHANDLER AZ
85225-7284
US

IV. Provider business mailing address

501 W RAY RD STE 6&7
CHANDLER AZ
85225-7284
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-9140
  • Fax: 480-383-6596
Mailing address:
  • Phone: 480-331-9140
  • Fax: 480-383-6596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5245
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5245
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: