Provider Demographics
NPI:1093774127
Name:MARTIN, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3801 WILLIAM D TATE AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8755
Mailing Address - Country:US
Mailing Address - Phone:817-488-6812
Mailing Address - Fax:817-251-1303
Practice Address - Street 1:601 WESTPARK WAY
Practice Address - Street 2:SUITE B
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3972
Practice Address - Country:US
Practice Address - Phone:817-283-5166
Practice Address - Fax:817-283-5176
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2019-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL3389207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7617368OtherAETNA
TX150569507Medicaid
TX207735OtherPACIFICARE
TX150569509Medicaid
8CE650OtherBCBS TX
P000789478OtherRAILROAD MEDICARE
TX207735OtherPACIFICARE
8F23374Medicare PIN