Provider Demographics
NPI:1942460340
Name:MARTIN, RUSSELL LIONEL (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:LIONEL
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 1:2225 E RANDOL MILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6315
Mailing Address - Country:US
Mailing Address - Phone:800-809-8875
Mailing Address - Fax:
Practice Address - Street 1:2225 E RANDOL MILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6315
Practice Address - Country:US
Practice Address - Phone:800-809-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine