Provider Demographics
NPI:1134180425
Name:DEVINE, MARTIN DOMINIC (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:DOMINIC
Last Name:DEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-5839
Mailing Address - Country:US
Mailing Address - Phone:877-960-3426
Mailing Address - Fax:559-793-3567
Practice Address - Street 1:1107 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5839
Practice Address - Country:US
Practice Address - Phone:877-960-3426
Practice Address - Fax:559-793-3567
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9077680OtherCIGNA HEALTH PLAN
42367OtherFALLON COMMUNITY HEALTH P
042472266OtherTHREE RIVERS
042472266OtherPRIVATE HEALTHCARE SYSTEM
MA3183475Medicaid
J19558OtherBLUE SHIELD INDEMNITY
J19558OtherBLUE SHIELD HMO BLUE
31001OtherHEALTHY START
2031301OtherFIRST HEALTH
31001OtherCHILDRENS MEDICAL SECURIT
3183475OtherMEDICAID WELFARE
5478684OtherAETNA US HEALTHCARE
J19558OtherBLUE CARE ELECT
042472266OtherONE HEALTH PLAN
155190OtherTUFTS HEALTH PLAN
71937OtherHARVARD PILGRIM HEALTHCAR
786721OtherMVP HEALTH CARE
042472266OtherTHREE RIVERS
155190OtherTUFTS HEALTH PLAN
2031301OtherFIRST HEALTH