Provider Demographics
NPI:1073534921
Name:ST JOHN, MARTHA WOLFRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:WOLFRAM
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:IRENE
Other - Last Name:WOLFRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14811 SAINT MARYS LN STE 270
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2908
Mailing Address - Country:US
Mailing Address - Phone:281-497-3500
Mailing Address - Fax:281-497-3512
Practice Address - Street 1:14811 SAINT MARYS LN STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2908
Practice Address - Country:US
Practice Address - Phone:281-497-3500
Practice Address - Fax:281-497-3512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL95002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry