Provider Demographics
NPI:1972532562
Name:MARTIN, ROBERT LEE JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7777 FOREST LN STE C630
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6857
Mailing Address - Country:US
Mailing Address - Phone:972-566-8520
Mailing Address - Fax:972-566-8594
Practice Address - Street 1:7777 FOREST LN STE C630
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6857
Practice Address - Country:US
Practice Address - Phone:972-566-8520
Practice Address - Fax:972-566-8594
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9619207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046067702Medicaid
TXD32190Medicare UPIN
TX8B2690Medicare PIN