| Doctor Name: | DR. NICHOLAUS BRUCE MARTIN |
| NPI Number: | 1629053236 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 40573 |
| Business Practice Address: | 120 W Fine Ave Flagstaff, AZ - 860013016 |
| Business Phone Number: | 9287739695 |
| Business Fax Number: | 9287730208 |
| Mailing Address: | 120 W Fine Ave, FLAGSTAFF |
| State: | AZ |
| Postal Code: | 860013016 |
| Phone Number: | 9287739695 |
| Fax Number: | 9287730208 |
| NPI Enumeration Date: | 12/07/2005 |
| NPI Last Update Date: | 01/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 40573 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |