Individual
W RANDY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 MEDICAL PLAZA DR, SUITE 190, ROSEVILLE, CA 95661-2865
(916) 786-7498
(916) 786-2715
Mailing address
3637 MISSION AVE, SUITE 7, CARMICHAEL, CA 95608-2946
(916) 786-7498
(916) 786-2715
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
G55146
CA
207RP1001X
Pulmonary Disease Physician
Primary
G55146
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G551460
—
CA
Enumeration date
06/14/2006
Last updated
02/28/2013
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