Provider Demographics
NPI:1649693565
Name:CORSTEN, MARTIN JOHN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOHN
Last Name:CORSTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8450
Mailing Address - Fax:817-378-3699
Practice Address - Street 1:4300 N CENTRAL EXPY STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6533
Practice Address - Country:US
Practice Address - Phone:214-823-3333
Practice Address - Fax:214-823-3355
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR1354207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology