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General NPI Number Information
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NPI Number | 1902831985
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Entity Type | Individual
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Provider Name | BROOKE G MARTIN PA
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 5150 JOURNAL CENTER BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-5900
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Country | US
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Telephone | 505-262-3233
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Fax | 505-262-3191
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Provider Business Mailing Address
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Address Line | PO BOX 26028
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6028
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Country | US
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Telephone | 505-262-7963
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Fax | 505-232-1627
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 78-PA005
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License Number State | NM
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