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1558034520

NPI Code Detail

MEDICARE: DR. MARTIN PAUL RICHARD MD

MEDICARE: DR. MARTIN PAUL RICHARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01098080A	IN
2	207Q00000X	Family Medicine Physician	78625	AZ
3	207Q00000X	Family Medicine Physician	036.177378	IL
4	207Q00000X	Family Medicine Physician	0101286697	VA
5	207Q00000X	Family Medicine Physician	MD492361C	PA
6	207Q00000X	Family Medicine Physician	ME177333	FL
7	207Q00000X	Family Medicine Physician	75901	TN
8	207Q00000X	Family Medicine Physician	W1669	TX
9	207Q00000X	Family Medicine Physician	CDR.0005937	CO
10	390200000X	Student in an Organized Health Care Education/Training Program	84142-20	WI

General Provider Information

NPI Number	:	1558034520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN PAUL RICHARD MD

Provider Business Mailing Address
First Line	:	300 W OAK ST STE 200
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-1400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W STOUT ST
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-5000
Country	:	US
Telephone Number	:	715-326-6291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	04/23/2026

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Directions to “ DR. MARTIN PAUL RICHARD MD” Practice Location

Language	Start Address	Practice Location

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