Individual
SAM MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2025 S BRENTWOOD BLVD, SUITE 200, BRENTWOOD, MO 63144-1833
(314) 918-1688
(844) 272-4251
Mailing address
7663 LINDBERGH DR, RICHMOND HEIGHTS, MO 63117-2137
(314) 743-6402
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
2005010629
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207302605
—
MO
Enumeration date
05/23/2006
Last updated
08/18/2014
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