Provider Demographics
NPI:1073580015
Name:KINNISON, MARTIN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:WILLIAM
Last Name:KINNISON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:CARL R. DARNALL ARMY MEDICAL CENTER, GENERAL SURGERY
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5095
Mailing Address - Country:US
Mailing Address - Phone:254-288-8464
Mailing Address - Fax:254-286-7188
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:CARL R. DARNALL ARMY MEDICAL CENTER, GENERAL SURGERY
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-288-8464
Practice Address - Fax:254-286-7188
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-07-17
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Provider Licenses
StateLicense IDTaxonomies
VA0101235355208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN