Provider Demographics
NPI:1831118579
Name:MARTIN, DAVID HUBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HUBERT
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 1:1542 TULANE AVE
Mailing Address - Street 2:DEPT. OF MEDICINE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-599-1457
Mailing Address - Fax:504-568-5553
Practice Address - Street 1:1542 TULANE AVE
Practice Address - Street 2:DEPT. OF MEDICINE
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:504-599-1457
Practice Address - Fax:504-568-5553
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05498R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114142Medicaid
LA1315974Medicaid
LA53802Medicare PIN
LA367138YH3UMedicare PIN
LAB64867Medicare UPIN
MS00114142Medicaid