Fenix R Martin, DNP

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R038864 Issued in SD

Practice address

355TH Medical Group
4175 S. Alamo Ave
Tucson, AZ 85707

Phone

(520) 228-2628

Fax

(520) 228-8890

NPI assigned

Mar 19, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1164008223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 S. ALAMO AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85707",
            "telephone_number": "520-228-2628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355TH MEDICAL GROUP",
            "address_2": "4175 S. ALAMO AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85707",
            "telephone_number": "520-228-2628",
            "fax_number": "520-228-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "FENIX",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-19",
        "last_updated": "2021-03-19",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SD",
            "license": "R038864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "R038864",
            "state": "SD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Tucson",
            "affiliation": "N",
            "endpointDescription": "355th Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Tucson",
            "address_1": "355th Medical Group",
            "address_2": "4175 S. Alamo Ave",
            "city": "Tucson",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "85707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David Jon Martin, M.D.
• Dawn Martin
• Debra Kay Martin, PHARMD
• Dorothy I Martin, LCSW
• Emily Martin
• Jacob Martin
• Jeffery Lynn Martin, D.D.S.
• Jeffrey Martin, PHARM D
• Jeffrey Fred Martin, O.D.
• Jennifer Joan Martin, M.D.

• Registered Nurse in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.