Individual
RUSSELL LEE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 VETERANS AVE, BECKLEY, WV 25801-6444
(304) 255-2121
Mailing address
775 MOUNT VIEW RD, COOL RIDGE, WV 25825-9511
(304) 228-0626
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
Other
Enumeration date
07/09/2007
Last updated
09/25/2007
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