Provider Demographics
NPI:1356485023
Name:MARTIN, BRIAN DAVID (CFA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DAVID
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:BOURG
Mailing Address - State:LA
Mailing Address - Zip Code:70343-0177
Mailing Address - Country:US
Mailing Address - Phone:985-594-6584
Mailing Address - Fax:
Practice Address - Street 1:218 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2768
Practice Address - Country:US
Practice Address - Phone:985-853-1390
Practice Address - Fax:985-850-5283
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF01313246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist