Provider Demographics
NPI:1407815467
Name:MARTIN, FREDRICK ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:ALLAN
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 1:813 FOUNDERS PARK DR E STE 107
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6321
Mailing Address - Country:US
Mailing Address - Phone:479-463-6600
Mailing Address - Fax:479-463-6624
Practice Address - Street 1:813 FOUNDERS PARK DR E STE 107
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6321
Practice Address - Country:US
Practice Address - Phone:479-463-6600
Practice Address - Fax:479-463-6624
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6262207Q00000X
ARC6262207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116105001Medicaid
AR53205OtherBCBS
AR5966210OtherAETNA
AR5393OtherCIGNA
AR110147646OtherRR MCR
AR341357OtherHEALTH LINK
AR1160902OtherFIRST HEALTH
AR120658OtherUNITED HEALTH CARE
AR13796000000OtherQUAL CHOICE
AR116105001Medicaid
AR53205OtherBCBS