Healthcare Provider Details

I. General information

NPI: 1316954860
Provider Name (Legal Business Name): ROBERT HARRELL MARTIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 CASTLE COAKLEY
CHRISTIANSTED VI
00820-5343
US

IV. Provider business mailing address

6040 CASTLE COAKLEY
CHRISTIANSTED VI
00820-5343
US

V. Phone/Fax

Practice location:
  • Phone: 340-998-2404
  • Fax:
Mailing address:
  • Phone: 340-998-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC8369
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: