Individual
NICOLAS CLAY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
12639 OLD TESSON RD STE 115, SAINT LOUIS, MO 63128
(314) 849-0311
(314) 849-4423
Mailing address
12639 OLD TESSON RD STE 115, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2005025463
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
304056609
—
MO
01
—
P00457779
RAILROAD MEDICARE
MO
Enumeration date
08/20/2006
Last updated
07/17/2019
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