Provider Demographics
NPI:1053317149
Name:MARTIN, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
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 1:820 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-907-1015
Mailing Address - Fax:615-907-6692
Practice Address - Street 1:820 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-907-1015
Practice Address - Fax:615-907-6692
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN265892082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1340038OtherUNITED HEALTHCARE
TN3090992Medicaid
TN3012386OtherBLUE CROSS BLUE SHIELD
TN1340038OtherUNITED HEALTHCARE
TNG03004Medicare UPIN