Healthcare Provider Details

I. General information

NPI: 1891743548
Provider Name (Legal Business Name): LAURA MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 N LOGAN ST STE 410
DENVER CO
80203-3155
US

IV. Provider business mailing address

PO BOX 7292; 3355 HUDSON STREET
DENVER CO
80207
US

V. Phone/Fax

Practice location:
  • Phone: 720-365-3277
  • Fax:
Mailing address:
  • Phone: 720-365-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number38091
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38091
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: