Provider Demographics
NPI:1083651681
Name:MARTIN, LUTHER CHATMAN (DO)
Entity Type:Individual
Prefix:
First Name:LUTHER
Middle Name:CHATMAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7119
Mailing Address - Country:US
Mailing Address - Phone:325-235-8641
Mailing Address - Fax:325-235-5925
Practice Address - Street 1:201 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7119
Practice Address - Country:US
Practice Address - Phone:325-235-8641
Practice Address - Fax:325-235-5925
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1227423-03Medicaid
TX89W542Medicare ID - Type UnspecifiedMEDICARE #
TX1227423-03Medicaid