Provider Demographics
NPI:1851308258
Name:MARTIN, KYLE PATTERSON (MD)
Entity Type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:PATTERSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:DEPT 95
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-1798
Mailing Address - Country:US
Mailing Address - Phone:901-752-4500
Mailing Address - Fax:901-260-5606
Practice Address - Street 1:7205 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1758
Practice Address - Country:US
Practice Address - Phone:901-752-4500
Practice Address - Fax:901-260-5606
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD37130207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4107689OtherBCBS
8474019OtherCIGNA
7211798OtherAETNA
TN4107689OtherBCBS
TN3330627Medicare PIN