| Doctor Name: | RICKY LEE MARTIN |
| NPI Number: | 1174880447 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | |
| Business Practice Address: | 4700 Las Vegas Blvd N Nellis Afb, NV - 891916600 |
| Business Phone Number: | 7026533969 |
| Business Fax Number: | |
| Mailing Address: | 675 E Azure Ave, Apt 3030 NORTH LAS VEGAS |
| State: | NV |
| Postal Code: | 890816886 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2012 |
| NPI Last Update Date: | 11/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |