Provider Demographics
NPI:1326107657
Name:MARTIN, GREGORY EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDWARD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:E
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550S MESA HILLS DR A4
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5758
Mailing Address - Country:US
Mailing Address - Phone:915-881-4681
Mailing Address - Fax:915-881-4675
Practice Address - Street 1:550S MESA HILLS DR A4
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5758
Practice Address - Country:US
Practice Address - Phone:915-881-4681
Practice Address - Fax:915-881-4675
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine