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General NPI Number Information
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NPI Number | 1013228394
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Entity Type | Individual
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Provider Name | CLINTON RICHARD MARTIN P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1951 MESQUITE AVE STE F
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5746
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Country | US
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Telephone | 928-963-9333
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Fax | 928-361-2611
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Provider Business Mailing Address
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Address Line | 9101 W SAHARA AVE # 105-51
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City | LAS VEGAS
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State | NV
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Zip | 89117-5772
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Country | US
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Telephone | 702-254-1425
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Fax | 702-243-5012
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5486
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1351
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12064
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0270
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License Number State | NV
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