Active NPI
Mitchell Lee Martin, P.A.
- Physician Assistant
- Lafayette, LA
National Provider Identifier
1679649792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- A10592
- Practice address
- 439 Heymann Blvd
Lafayette, LA 70503-2616 - Phone
- (337) 269-0963
- Fax
- (337) 269-0553
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | A10592 | LA | Primary |
Addresses
Primary practice location
439 Heymann Blvd
Lafayette, LA 70503-2616
Mailing address
601 W Saint Mary Blvd
Suite 500
Lafayette, LA 70506-3568
Phone (337) 269-0963
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A10592 | LA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620000000000",
"number": "1679649792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 W SAINT MARY BLVD",
"address_2": "SUITE 500",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705063568",
"telephone_number": "337-269-0963",
"fax_number": "337-269-0553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "439 HEYMANN BLVD",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705032616",
"telephone_number": "337-269-0963",
"fax_number": "337-269-0553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "MITCHELL",
"middle_name": "LEE",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2021-05-03",
"certification_date": "2021-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "LA",
"license": "A10592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.