Provider Demographics
NPI:1447208954
Name:MARTIN, PATRICIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
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:PO BOX 504407
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4407
Mailing Address - Country:US
Mailing Address - Phone:816-932-7940
Mailing Address - Fax:816-932-7957
Practice Address - Street 1:12300 METCALF AVE
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:816-932-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109241207L00000X
KS0425807207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22194015OtherMO BCBS NUMBER
KS22194045OtherKS BCBS NUMBER
MO050063975OtherMO RR MEDICARE NUMBER
KS100182470DMedicaid
KS050070663OtherKS RR MEDICARE NUMBER
MO208107508Medicaid
KS22194045OtherKS BCBS NUMBER
MO208107508Medicaid
KS050070663OtherKS RR MEDICARE NUMBER
MOE78081Medicare UPIN
MOJ248930Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MOW19000216Medicare PIN