Provider Demographics
NPI:1871529677
Name:MARTIN, WILLIAM A (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:265 CAMINO AL BARRANCO
Mailing Address - Street 2:
Mailing Address - City:LA SELVA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:95076-1505
Mailing Address - Country:US
Mailing Address - Phone:831-688-2455
Mailing Address - Fax:408-340-5905
Practice Address - Street 1:265 CAMINO AL BARRANCO
Practice Address - Street 2:
Practice Address - City:LA SELVA BEACH
Practice Address - State:CA
Practice Address - Zip Code:95076-1505
Practice Address - Country:US
Practice Address - Phone:831-331-6239
Practice Address - Fax:408-342-1972
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62363208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE75086Medicare UPIN
00G623630Medicare ID - Type Unspecified