Provider Demographics
NPI:1053874305
Name:MARTIN, TRAVIS PATRICK (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:PATRICK
Last Name:MARTIN
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 1:26603 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4313
Mailing Address - Country:US
Mailing Address - Phone:951-217-1250
Mailing Address - Fax:
Practice Address - Street 1:1850 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4621
Practice Address - Country:US
Practice Address - Phone:909-887-2991
Practice Address - Fax:909-887-2991
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA184909207P00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine