MEDICARE: DAWN MARTIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	E2057	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18357000000	OTHER	AR	QUALCHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	423160	OTHER	AR	HEALTHLINK
4	7218039	OTHER	AR	AETNA

General Provider Information

NPI Number	:	1871557157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN MARTIN MD

Provider Business Mailing Address
First Line	:	904 AUTUMN RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3742
Country	:	US
Telephone Number	:	501-224-5437
Fax Number	:	501-224-3473

Provider Business Practice Location Address
First Line	:	904 AUTUMN RD
Second Line	:	SUITE100
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3742
Country	:	US
Telephone Number	:	501-224-5437
Fax Number	:	501-224-3473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	11/03/2011

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Directions to “ DAWN MARTIN MD” Practice Location

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