Michael J Martino, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DR36536 Issued in CO

Practice address

1200 Carson Ave Ste 102
La Junta, CO 81050-2700

Phone

(719) 383-5970

Fax

(719) 383-5974

NPI assigned

Jul 2, 2006

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1811926561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CARSON AVE STE 102",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810502700",
            "telephone_number": "719-383-5970",
            "fax_number": "719-383-5974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CARSON AVE STE 102",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810502700",
            "telephone_number": "719-383-5970",
            "fax_number": "719-383-5974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINO",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-02",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR36536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "80164496",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "MAM6084",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01365360",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ayanna Rae Marshall, M.S.
• Sharron Suzette Marshall
• Joslin Martin
• Melanie Erin Martinez, LPC
• Patrick Robert Martinez, LPC
• Donna Maurer, B.S.
• Maxim Healthcare Services, Inc.
• Maxim Healthcare Services,Inc.
• Kathy Ray McCoy, RPH
• Malyka May Medina, PHARM D

• Family Medicine Physician in La Junta, CO
• Providers in La Junta, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; 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.