Provider Demographics
NPI:1003106188
Name:MARTIN, BRIAN K (CST)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 ASHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-2608
Mailing Address - Country:US
Mailing Address - Phone:832-948-4134
Mailing Address - Fax:
Practice Address - Street 1:958 ASHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-2608
Practice Address - Country:US
Practice Address - Phone:832-948-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94675246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist