Provider Demographics
NPI:1093830150
Name:MARTIN, TERRI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:POOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16115 SAINT VINCENT WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3000
Mailing Address - Country:US
Mailing Address - Phone:501-817-3923
Mailing Address - Fax:501-817-3930
Practice Address - Street 1:16115 SAINT VINCENT WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3000
Practice Address - Country:US
Practice Address - Phone:501-817-3923
Practice Address - Fax:501-817-3930
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1302207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131957001Medicaid
AR5K479Medicare PIN