Provider Demographics
NPI:1609844356
Name:MARTIN, WILLIAM P (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
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 1:1339 EAST ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4228
Mailing Address - Country:US
Mailing Address - Phone:940-521-5500
Mailing Address - Fax:940-521-5511
Practice Address - Street 1:1339 EAST ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4228
Practice Address - Country:US
Practice Address - Phone:940-521-5500
Practice Address - Fax:940-521-5511
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080188878OtherRAILROAD MEDICARE
TX116618307OtherTX HEALTH STEPS (MEDICAID)
TX8AJ159OtherBCBS
TX116618308Medicaid
TX116618308Medicaid
TX080188878OtherRAILROAD MEDICARE