Provider Demographics
NPI:1194859553
Name:RAYMOND-MARTIMBEAU, PAULINE (MD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:RAYMOND-MARTIMBEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 GLEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4307
Mailing Address - Country:US
Mailing Address - Phone:214-691-2331
Mailing Address - Fax:214-369-5019
Practice Address - Street 1:5439 GLEN LAKES DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4307
Practice Address - Country:US
Practice Address - Phone:214-691-2331
Practice Address - Fax:214-369-5019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG-7315261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGH-55Medicare ID - Type Unspecified