Healthcare Provider Details

I. General information

NPI: 1659734580
Provider Name (Legal Business Name): RYAN CHRISTOPHER MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1155 BAYSWATER AVE APT 201
BURLINGAME CA
94010-4303
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8000
  • Fax:
Mailing address:
  • Phone: 301-655-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA154538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: