Provider Demographics
NPI:1003894148
Name:KRECKER, MARTIN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:THOMAS
Last Name:KRECKER
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 1:5022 OLD GODSEY LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-6600
Mailing Address - Country:US
Mailing Address - Phone:423-870-0558
Mailing Address - Fax:423-870-4513
Practice Address - Street 1:5022 OLD GODSEY LN
Practice Address - Street 2:SUITE 10
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6600
Practice Address - Country:US
Practice Address - Phone:423-870-0558
Practice Address - Fax:423-870-4513
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029095173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3811713Medicare ID - Type Unspecified
TNE95216Medicare UPIN