Provider Demographics
NPI:1912114307
Name:MARTIN, DAVID LEE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
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 1:12325 HYMEADOW DR STE 2-103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1847
Mailing Address - Country:US
Mailing Address - Phone:512-258-2500
Mailing Address - Fax:512-258-2329
Practice Address - Street 1:12325 HYMEADOW DR STE 2-103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1847
Practice Address - Country:US
Practice Address - Phone:512-258-2500
Practice Address - Fax:512-258-2329
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6406208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD49741Medicare UPIN
TX00T27FMedicare ID - Type Unspecified