Provider Demographics
NPI:1205233020
Name:MARTIN, ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 HARRIS PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4272
Mailing Address - Country:US
Mailing Address - Phone:817-632-0020
Mailing Address - Fax:817-632-0022
Practice Address - Street 1:6930 HARRIS PKWY STE 130
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4272
Practice Address - Country:US
Practice Address - Phone:817-632-0020
Practice Address - Fax:817-632-0022
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant