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General NPI Number Information
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NPI Number | 1053874305
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Entity Type | Individual
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Provider Name | TRAVIS PATRICK MARTIN MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 1850 E WASHINGTON ST
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City | COLTON
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State | CA
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Zip | 92324-4621
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Country | US
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Telephone | 909-887-2991
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Fax | 909-887-2991
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Provider Business Mailing Address
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Address Line | 26603 EUREKA ST
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City | REDLANDS
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State | CA
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Zip | 92373-4313
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Country | US
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Telephone | 951-217-1250
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A184909
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | A184909
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License Number State | CA
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