Provider Demographics
NPI:1114195104
Name:DAVID E MARTIN MD, PA
Entity Type:Organization
Organization Name:DAVID E MARTIN MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EXLINE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-6988
Mailing Address - Street 1:7777 FOREST LN STE C625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-7520
Mailing Address - Country:US
Mailing Address - Phone:972-566-6988
Mailing Address - Fax:972-566-6108
Practice Address - Street 1:7777 FOREST LN STE C625
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-7520
Practice Address - Country:US
Practice Address - Phone:972-566-6988
Practice Address - Fax:972-566-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5334208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty