Individual
DR. NICHOLAUS BRUCE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 W FINE AVE, FLAGSTAFF, AZ 86001-3016
(928) 773-9695
(928) 773-0208
Mailing address
120 W FINE AVE, FLAGSTAFF, AZ 86001-3016
(928) 773-9695
(928) 773-0208
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
18430
AZ
208D00000X
General Practice Physician
40573
CO
Other
Enumeration date
12/07/2005
Last updated
01/22/2010
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