Individual
MR. CLINTON RICHARD MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1951 MESQUITE AVE STE F, LAKE HAVASU CITY, AZ 86403-5746
(928) 963-9333
(928) 361-2611
Mailing address
9101 W SAHARA AVE # 105-51, LAS VEGAS, NV 89117-5772
(702) 254-1425
(702) 243-5012
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5486
AZ
363A00000X
Physician Assistant
PA0270
NV
363A00000X
Physician Assistant
PA12064
TX
363A00000X
Physician Assistant
PA1351
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013228394
—
NV
05
—
1366544124
—
NV
05
—
137949
—
AZ
Enumeration date
07/01/2010
Last updated
10/23/2024
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