Provider Demographics
NPI:1821085531
Name:MARTIN, ANGEL S (MD)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:S
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 1:321 E 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3210
Mailing Address - Country:US
Mailing Address - Phone:641-792-7640
Mailing Address - Fax:641-792-4029
Practice Address - Street 1:321 E 3RD ST N
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3210
Practice Address - Country:US
Practice Address - Phone:641-792-7640
Practice Address - Fax:641-792-4029
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20656208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2133348Medicaid
13334OtherBCBS
A01178Medicare UPIN
I4281Medicare ID - Type Unspecified