Provider Demographics
NPI:1780661892
Name:MARTIN, CHARLES R (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:MARTIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:703 E MARSHALL AVE
Mailing Address - Street 2:STE 3008
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5500
Mailing Address - Country:US
Mailing Address - Phone:903-315-2740
Mailing Address - Fax:903-315-2742
Practice Address - Street 1:703 E MARSHALL AVE
Practice Address - Street 2:STE 3008
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5500
Practice Address - Country:US
Practice Address - Phone:903-315-2740
Practice Address - Fax:903-315-2742
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2011-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH5255207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG41130Medicare UPIN