Individual
DR. RANDALL LEE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
204 MCCOLLUM DRIVE, SUITE 101, LARAMIE, WY 82070
(307) 745-6065
(307) 745-4936
Mailing address
22187 SE LAFAYETTE HWY, DAYTON, OR 97114-8818
(503) 868-7770
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
60771584
WA
207L00000X
Anesthesiology Physician
MD14891
OR
207L00000X
Anesthesiology Physician
TL1962
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176917
—
OR
05
—
200948040
—
IN
Enumeration date
07/18/2006
Last updated
05/15/2018
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