Healthcare Provider Details

I. General information

NPI: 1215906516
Provider Name (Legal Business Name): ROBERT WILLIAM MARTIN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 CHESTNUT ST
EVANSVILLE IN
47713-1227
US

IV. Provider business mailing address

PO BOX 3868
EVANSVILLE IN
47737-3868
US

V. Phone/Fax

Practice location:
  • Phone: 812-426-9355
  • Fax: 812-858-4539
Mailing address:
  • Phone: 812-426-9355
  • Fax: 812-858-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01044875A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: