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General NPI Number Information
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NPI Number | 1386221802
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Entity Type | Individual
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Provider Name | JORDIE MARTIN MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 3616 CAMPUS BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1314
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Country | US
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Telephone | 505-908-3826
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Fax |
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Provider Business Mailing Address
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Address Line | 1933 SAN MATEO BLVD NE PMB 231
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City | ALBUQUERQUE
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State | NM
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Zip | 87110
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Country | US
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Telephone | 505-908-3826
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Fax | 505-966-9597
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD2024-0106
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License Number State | NM
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