Provider Demographics
NPI:1184935447
Name:MARTINEAU, DAVID L (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:MARTINEAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5083
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-5083
Mailing Address - Country:US
Mailing Address - Phone:901-383-9437
Mailing Address - Fax:
Practice Address - Street 1:7600 WOLF RIVER BLVD
Practice Address - Street 2:STE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1784
Practice Address - Country:US
Practice Address - Phone:901-747-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30452085R0202X
390200000X
ALDO.15052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program