Individual
MARK W MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 NW MURRAY RD, SUITE 210, LEES SUMMIT, MO 64081-1204
(816) 524-2626
(816) 524-0173
Mailing address
600 NW MURRAY RD, SUITE 210, LEES SUMMIT, MO 64081-1204
(816) 524-2626
(816) 524-0173
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD 35980
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100453490A
—
KS
05
—
201211018
—
MO
Enumeration date
09/20/2005
Last updated
12/21/2009
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