Healthcare Provider Details

I. General information

NPI: 1386221802
Provider Name (Legal Business Name): JORDIE MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 CAMPUS BLVD NE
ALBUQUERQUE NM
87106-1314
US

IV. Provider business mailing address

1933 SAN MATEO BLVD NE PMB 231
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-3826
  • Fax:
Mailing address:
  • Phone: 505-908-3826
  • Fax: 505-966-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2024-0106
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: