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General NPI Number Information
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NPI Number | 1851475610
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Entity Type | Individual
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Provider Name | RICHARD LEROY MARTIN JR. DPM
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 3800 W RAY RD STE 5
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City | CHANDLER
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State | AZ
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Zip | 85226-5940
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Country | US
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Telephone | 480-718-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 25138 W. BLUE SKY DRIVE
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City | WHITTMANN
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State | AZ
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Zip | 85361
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Country | US
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Telephone | 740-312-3140
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD-000813
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36003308M
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License Number State | OH
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