Provider Demographics
NPI:1427157148
Name:MARTIN, JAMES ROBERT (MPAS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MPAS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:435-628-9393
Mailing Address - Fax:435-628-9382
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:STE 150
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-628-9393
Practice Address - Fax:435-628-9382
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT288527-12062080A0000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine