Provider Demographics
NPI:1073834404
Name:MARTIN, ROBERT AMBROSE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:AMBROSE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 RUSTIC RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-3323
Mailing Address - Country:US
Mailing Address - Phone:334-552-9074
Mailing Address - Fax:
Practice Address - Street 1:945 RUSTIC RIDGE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-3323
Practice Address - Country:US
Practice Address - Phone:334-552-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32892207Q00000X
GA071595207QS0010X
TXV3047207QS0010X
ALMD.43674207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine