Provider Demographics
NPI:1841378536
Name:MARTIN, DAVID EXLINE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EXLINE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:BUILDING C SUITE 625
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-6988
Mailing Address - Fax:972-566-6108
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:BUILDING C SUITE 625
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-6988
Practice Address - Fax:972-566-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX#G5334208200000X
TXG53342086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD66879Medicare UPIN
TX00T39WMedicare ID - Type Unspecified