Provider Demographics
NPI:1235490046
Name:MARTIN, TAMARA MCPETERS (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MCPETERS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7132
Mailing Address - Country:US
Mailing Address - Phone:972-740-5572
Mailing Address - Fax:972-570-5672
Practice Address - Street 1:3626 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3643
Practice Address - Country:US
Practice Address - Phone:972-256-2028
Practice Address - Fax:972-570-5672
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03456363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical