Provider Demographics
NPI:1427149194
Name:NAUGHTON, MARTIN J (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:NAUGHTON
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 1:9850 HAFFLINGER LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4389
Mailing Address - Country:US
Mailing Address - Phone:775-762-4477
Mailing Address - Fax:855-202-8485
Practice Address - Street 1:1500 E 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1189
Practice Address - Country:US
Practice Address - Phone:775-982-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016982Medicaid
NVV101207Medicare PIN
NVC96387Medicare UPIN
NV002016982Medicaid