Provider Demographics
NPI:1205963261
Name:MARTIN, JOAN B (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4700
Mailing Address - Country:US
Mailing Address - Phone:303-339-0093
Mailing Address - Fax:
Practice Address - Street 1:9400 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4700
Practice Address - Country:US
Practice Address - Phone:303-339-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01231539Medicaid
COA37467Medicare UPIN
CO01231539Medicaid