Provider Demographics
NPI:1366430498
Name:MARTIN, LAWRENCE MATHER (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MATHER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4300 N MILLER RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3619
Mailing Address - Country:US
Mailing Address - Phone:480-699-3860
Mailing Address - Fax:480-699-3971
Practice Address - Street 1:4300 N MILLER RD
Practice Address - Street 2:SUITE 218
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3619
Practice Address - Country:US
Practice Address - Phone:480-699-3860
Practice Address - Fax:480-699-3971
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ180402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0736820OtherBCBS
AZ86080015085259A115OtherTRICARE - FOR MAYO CLINIC
AZZ26WCGTB06Medicare PIN
75404WCLDWMedicare PIN
D81639Medicare UPIN