Provider Demographics
NPI:1902020225
Name:MARTIN, DAN FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:FRANKLIN
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 1:6133 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2459
Mailing Address - Country:US
Mailing Address - Phone:361-881-8333
Mailing Address - Fax:
Practice Address - Street 1:6133 PARKWAY
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2459
Practice Address - Country:US
Practice Address - Phone:361-881-8333
Practice Address - Fax:361-881-8753
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
TXN3166208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206766201Medicaid
8L17330Medicare PIN