Provider Demographics
NPI:1942297536
Name:GERTEISEN, MARTHA FRANCES (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:FRANCES
Last Name:GERTEISEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 W. BROADWAY STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:281-485-4050
Mailing Address - Fax:281-485-6850
Practice Address - Street 1:8520 W. BROADWAY STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:281-485-4050
Practice Address - Fax:281-485-6850
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5539207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01316162OtherRR MEDICARE
TXP01643107OtherRR MEDICARE
TX8FT479OtherBCBS
TX121369614Medicaid
TX8EB342OtherBCBS
TX8FT479OtherBLUE CROSS BLUE SHIELD
TX121369613Medicaid
TX8FT479OtherBCBS
TXP01643107OtherRR MEDICARE
TX8EB342OtherBCBS
TX121369613Medicaid