Provider Demographics
NPI:1013905306
Name:MARTIN, PAMELA BROOKE (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:BROOKE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4351 BOOTH CALLOWAY RD
Mailing Address - Street 2:#101
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7378
Mailing Address - Country:US
Mailing Address - Phone:817-284-1165
Mailing Address - Fax:817-284-4990
Practice Address - Street 1:300 N RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4235
Practice Address - Country:US
Practice Address - Phone:817-753-7300
Practice Address - Fax:817-431-0367
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T83UMedicare PIN
TXE38181Medicare UPIN