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NPI Code Detail

MEDICARE: MR. SAMUEL TRAVIS MARTIN

MEDICARE: MR. SAMUEL TRAVIS MARTIN
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
1367500000XCertified Registered Nurse Anesthetist6565NC

General Provider Information

NPI Number : 1831789544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SAMUEL TRAVIS MARTIN
Provider Business Mailing Address
First Line : 520 STONEY CREEK AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-8186
Country : US
Telephone Number : 907-350-4439
Fax Number :
Provider Business Practice Location Address
First Line : 3400 WAKE FOREST RD
Second Line :
City : RALEIGH
State : NC
Zip : 27609-7317
Country : US
Telephone Number : 919-954-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2021
Last Update Date : 01/26/2021

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Directions to “ MR. SAMUEL TRAVIS MARTIN ” Practice Location

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