Provider Demographics
NPI:1750350369
Name:MARTIN, DAVID ROBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3260
Mailing Address - Country:US
Mailing Address - Phone:712-792-9782
Mailing Address - Fax:712-792-6019
Practice Address - Street 1:302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3260
Practice Address - Country:US
Practice Address - Phone:712-792-9782
Practice Address - Fax:712-792-6019
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA362974363213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0195149Medicaid
IAT01124Medicare UPIN
IA0195149Medicaid