Provider Demographics
NPI:1326087081
Name:MARTIN, BRUCE G (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7711 LOUIS PASTEUR DR
Mailing Address - Street 2:SUITE 901/905
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3415
Mailing Address - Country:US
Mailing Address - Phone:210-616-0690
Mailing Address - Fax:210-614-8746
Practice Address - Street 1:7711 LOUIS PASTEUR DR
Practice Address - Street 2:SUITE 901/905
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3415
Practice Address - Country:US
Practice Address - Phone:210-616-0690
Practice Address - Fax:210-614-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8728207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67375Medicare UPIN
TX80141BMedicare ID - Type Unspecified