Individual
DR. JOHN BLANCHARD MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
1215 N BEAVER ST, FLAGSTAFF, AZ 86001-3126
(928) 773-2200
(928) 773-2300
Mailing address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4397
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1716-057
WI LICENSE NUMBER
WI
05
—
810762
—
AZ
Enumeration date
06/26/2006
Last updated
05/25/2021
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