Provider Demographics
NPI:1326005927
Name:MARTIN, RODNEY A (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 PEABODY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3550
Mailing Address - Country:US
Mailing Address - Phone:901-276-6000
Mailing Address - Fax:901-276-4000
Practice Address - Street 1:1286 PEABODY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3550
Practice Address - Country:US
Practice Address - Phone:901-276-6000
Practice Address - Fax:901-276-4000
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19088208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3066241Medicaid
TN162842OtherBCBS
F20236Medicare UPIN
TN3066241Medicaid