Provider Demographics
NPI:1316954860
Name:MARTIN, ROBERT HARRELL JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HARRELL
Last Name:MARTIN
Suffix:JR
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 1:6040 CASTLE COAKLEY
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-5343
Mailing Address - Country:US
Mailing Address - Phone:340-998-2404
Mailing Address - Fax:
Practice Address - Street 1:6040 CASTLE COAKLEY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-5343
Practice Address - Country:US
Practice Address - Phone:340-998-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J056OtherBCBS
AR123419001Medicaid
AR5J056Medicare PIN
ARF38394Medicare UPIN