Healthcare Provider Details

I. General information

NPI: 1689617888
Provider Name (Legal Business Name): ANGELIA D. MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 E US HIGHWAY 136 NMC ALBANY CLINIC EAST
ALBANY MO
64402-8223
US

IV. Provider business mailing address

1607 E US HIGHWAY 136 NMC ALBANY CLINIC EAST
ALBANY MO
64402-8223
US

V. Phone/Fax

Practice location:
  • Phone: 660-726-3333
  • Fax: 660-726-3232
Mailing address:
  • Phone: 660-726-3333
  • Fax: 660-726-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number115802
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: