Provider Demographics
NPI:1659304566
Name:GORDON H MARTIN MD PA
Entity Type:Organization
Organization Name:GORDON H MARTIN MD PA
Other - Org Name:GORDON H MARTIN MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-332-3142
Mailing Address - Street 1:333 N TEXAS AVE
Mailing Address - Street 2:STE 4200
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4966
Mailing Address - Country:US
Mailing Address - Phone:281-332-3142
Mailing Address - Fax:281-332-7568
Practice Address - Street 1:333 N TEXAS AVE
Practice Address - Street 2:STE 4200
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4966
Practice Address - Country:US
Practice Address - Phone:281-332-3142
Practice Address - Fax:281-332-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5107174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDE8937OtherRAILROAD MEDICARE
TX0041NZOtherBCBS
TX197308302Medicaid
TXDE8937OtherRAILROAD MEDICARE
TXG99799Medicare UPIN