Provider Demographics
NPI:1972598456
Name:MARTZ, RANDALL STUART (PAC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:STUART
Last Name:MARTZ
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 OAKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-6642
Mailing Address - Country:US
Mailing Address - Phone:940-612-1662
Mailing Address - Fax:
Practice Address - Street 1:1512 TEASLEY LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7282
Practice Address - Country:US
Practice Address - Phone:940-566-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00020363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81N448Medicare ID - Type Unspecified