Individual
RICKY LEE MARTIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2326 18TH ST STE 210, COLUMBUS, IN 47201-5362
(812) 372-8680
(812) 373-5497
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002016A
IN
363AM0700X
Medical Physician Assistant
10002016A
IN
Other
Enumeration date
04/11/2012
Last updated
09/06/2024
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