Healthcare Provider Details

I. General information

NPI: 1356318794
Provider Name (Legal Business Name): ROBERT EDWARD MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21030 REDWOOD RD
CASTRO VALLEY CA
94546-5920
US

IV. Provider business mailing address

23 RAILROAD AVE UNIT 1314
DANVILLE CA
94526-1142
US

V. Phone/Fax

Practice location:
  • Phone: 510-247-8281
  • Fax: 510-247-8280
Mailing address:
  • Phone: 510-247-8281
  • Fax: 510-247-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG671850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: