Provider Demographics
NPI:1326046244
Name:MARTIN, DAVID THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
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 1:1549 AIRPORT BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8633
Mailing Address - Country:US
Mailing Address - Phone:850-416-4960
Mailing Address - Fax:850-416-4961
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-416-4960
Practice Address - Fax:850-416-4961
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262144403Medicaid
FL262144403Medicaid
H41805Medicare UPIN