Provider Demographics
NPI:1083875751
Name:MARTIN, TOM PEARCE (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:PEARCE
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 1:10900 PORTER LN
Mailing Address - Street 2:
Mailing Address - City:JUNCTION
Mailing Address - State:IL
Mailing Address - Zip Code:62954-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10900 PORTER LN
Practice Address - Street 2:
Practice Address - City:JUNCTION
Practice Address - State:IL
Practice Address - Zip Code:62954-2200
Practice Address - Country:US
Practice Address - Phone:618-269-4034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-049331261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care