Provider Demographics
NPI:1841285756
Name:MARTIN, GEORGE JOHN (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOHN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4726
Mailing Address - Country:US
Mailing Address - Phone:915-590-2225
Mailing Address - Fax:915-590-2229
Practice Address - Street 1:1725 BROWN ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4726
Practice Address - Country:US
Practice Address - Phone:915-590-2225
Practice Address - Fax:915-590-2229
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77582207T00000X
TXM8814207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256756300Medicaid
TX197232501Medicaid
TX197232501Medicaid
FL46374ZMedicare ID - Type Unspecified