Provider Demographics
NPI:1659353605
Name:FIELDER, MARTIN W (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:W
Last Name:FIELDER
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:PO BOX 1367
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-1367
Mailing Address - Country:US
Mailing Address - Phone:903-439-4917
Mailing Address - Fax:903-885-5726
Practice Address - Street 1:113 AIRPORT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2193
Practice Address - Country:US
Practice Address - Phone:903-439-4917
Practice Address - Fax:903-885-5726
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8336207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01112631OtherRAILROAD MEDICARE
TX179333303Medicaid
TX179333303Medicaid