Healthcare Provider Details

I. General information

NPI: 1952388357
Provider Name (Legal Business Name): STEPHEN CRAIG MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 10/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4288
US

IV. Provider business mailing address

1905 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4288
US

V. Phone/Fax

Practice location:
  • Phone: 970-947-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR. 0054363
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH8233
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: