Individual
GLENN WILLIAM MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C.
Contact information
Practice address
2700 FARMINGTON AVE, FARMINGTON, NM 87401-4559
(505) 325-1100
(505) 325-5044
Mailing address
4971 COUNTY ROAD 250, DURANGO, CO 81301-8620
(970) 247-2982
(970) 247-2982
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
77 PA 005 NM
NM
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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