Provider Demographics
NPI:1225025968
Name:MARTIN, WILLIAM ROBERT III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MARTIN
Suffix:III
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 1:4430 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-9098
Mailing Address - Country:US
Mailing Address - Phone:573-596-0417
Mailing Address - Fax:
Practice Address - Street 1:4430 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-9098
Practice Address - Country:US
Practice Address - Phone:735-960-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22049207X00000X
AK7834207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00217224OtherRAILROAD MEDICARE
AZ22049OtherSTATE LICENSE
AZZ84076OtherMEDICARE INDIVIDUAL PIN
AZ083009OtherMEDICAID URGENT CARE
AZ397621Medicaid
AZZ84078OtherMEDICARE ID-PIN
AZZ84076OtherMEDICARE INDIVIDUAL PIN
AZ397621Medicaid