Provider Demographics
NPI:1326047556
Name:MARTIN, HARVEY C (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:C
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 1:1808 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4219
Mailing Address - Country:US
Mailing Address - Phone:940-723-4488
Mailing Address - Fax:940-723-0446
Practice Address - Street 1:1808 ROSE ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4219
Practice Address - Country:US
Practice Address - Phone:940-723-4488
Practice Address - Fax:940-723-0446
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-10-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TXF27892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX775869OtherFIRST HEALTH CCN
TX00RD99OtherBLUE CROSS BLUE SHIELD
TX254835OtherCOMPSYCH
TX4649932OtherAETNA BEHAVIORAL HEALTH
TX128105OtherMHN
TXMDF2789OtherWORKERS COMPENSATION
OK100197120AMedicaid
TX124488OtherSUPERIOR
TX283144OtherVALUEOPTIONS
TX126465710Medicaid
TX124488OtherSUPERIOR