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Individual
DR. MARK LEE MARTIN
Active
Individual
DR. MARK LEE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
31429
MN
207Q00000X
Family Medicine Physician
31429
MN
208100000X
Physical Medicine & Rehabilitation Physician
31429
MN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
31429
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3M316MA
BLUE CROSS/BLUE SHIELD
MN
05
—
826787100
—
MN
Enumeration date
06/09/2006
Last updated
10/04/2011
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