Provider Demographics
NPI:1043247422
Name:MARTIN, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:6106 S COUNTY ROAD 800 E
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:IN
Mailing Address - Zip Code:46994-8999
Mailing Address - Country:US
Mailing Address - Phone:574-721-7898
Mailing Address - Fax:574-212-0643
Practice Address - Street 1:6106 S COUNTY ROAD 800 E
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:IN
Practice Address - Zip Code:46994-8999
Practice Address - Country:US
Practice Address - Phone:574-721-7898
Practice Address - Fax:574-212-0643
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010491342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200180130Medicaid
INCF3161OtherRAILROAD MEDICARE
ING74506Medicare UPIN