Provider Demographics
NPI:1598742355
Name:MARTIN, LORENZO (MD)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
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 1:1406 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-1700
Mailing Address - Country:US
Mailing Address - Phone:361-887-8811
Mailing Address - Fax:361-887-8874
Practice Address - Street 1:1406 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-1700
Practice Address - Country:US
Practice Address - Phone:361-887-8811
Practice Address - Fax:361-887-8874
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8336207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C18830Medicare UPIN