Provider Demographics
NPI:1801859434
Name:MARTIN, JAMES RICK (DO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RICK
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150337
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-0037
Mailing Address - Country:US
Mailing Address - Phone:936-634-1746
Mailing Address - Fax:936-634-1746
Practice Address - Street 1:1807 W FRANK
Practice Address - Street 2:SUITE 100
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-634-1746
Practice Address - Fax:936-634-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033395701Medicaid
TXFU61OtherBLUE CROSS
TX00FU61Medicare PIN
TX033395701Medicaid