Healthcare Provider Details

I. General information

NPI: 1750354007
Provider Name (Legal Business Name): LISA P MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E 13TH ST
MURFREESBORO AR
71958-9541
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 870-285-3118
  • Fax: 870-285-2759
Mailing address:
  • Phone: 870-285-3118
  • Fax: 870-285-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL9797
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-6526
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: