Individual
TRACY B MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2610 TRINITY DR STE 14, LOS ALAMOS, NM 87544-2362
(505) 500-8213
(505) 451-0580
Mailing address
3500 TRINITY DR STE C3, LOS ALAMOS, NM 87544-2221
(505) 500-8213
(505) 391-8935
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
99PA28
NM
363A00000X
Physician Assistant
Primary
99-PA28
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000N1651
—
NM
01
—
10029201
LOVELACE
—
01
—
QMP000003399104
MOLINA
—
Enumeration date
12/06/2006
Last updated
10/11/2022
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