Provider Demographics
NPI:1093847915
Name:MARTIN, THOMAS E (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:E
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-1529
Mailing Address - Country:US
Mailing Address - Phone:406-338-6339
Mailing Address - Fax:
Practice Address - Street 1:BLACKFEET COMMUNITY HOSPITAL
Practice Address - Street 2:760 HOSPITAL CIRCLE
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8854103T00000X
CAPSY8854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP37720Medicare UPIN