Healthcare Provider Details

I. General information

NPI: 1326353335
Provider Name (Legal Business Name): ALEXANDER DAVID MARTIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SOUTH ASPEN STREET, STOP 89 460 MDG/SGHC
BUCKLEY AFB CO
80011-9547
US

IV. Provider business mailing address

24941 E EUCLID PL
AURORA CO
80016-2464
US

V. Phone/Fax

Practice location:
  • Phone: 720-847-6486
  • Fax:
Mailing address:
  • Phone: 303-617-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193067
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number505191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: