Provider Demographics
NPI:1346622024
Name:MARTIN, NICHOLAS EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EUGENE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2901 ACME BRICK PLZ
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4124
Mailing Address - Country:US
Mailing Address - Phone:817-529-1900
Mailing Address - Fax:817-529-1910
Practice Address - Street 1:305 REGENCY PKWY STE 405
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5169
Practice Address - Country:US
Practice Address - Phone:817-968-5806
Practice Address - Fax:915-703-7745
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT1458207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery