Provider Demographics
NPI:1093759896
Name:MARTIN, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:811 W I-20
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5870
Mailing Address - Country:US
Mailing Address - Phone:817-468-3393
Mailing Address - Fax:817-468-8734
Practice Address - Street 1:811 INTERSTATE 20 W
Practice Address - Street 2:SUITE 120
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5870
Practice Address - Country:US
Practice Address - Phone:817-468-3393
Practice Address - Fax:817-468-8734
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF5295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131903006Medicaid
TX110094175OtherRAILROAD MEDICARE
TX131903007Medicaid
TX131903007Medicaid
TX80X109Medicare PIN