Healthcare Provider Details

I. General information

NPI: 1265422760
Provider Name (Legal Business Name): ROBERT P MARTYN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 DOHI DR
LOUDON TN
37774-2851
US

IV. Provider business mailing address

202 DOHI DR
LOUDON TN
37774-2851
US

V. Phone/Fax

Practice location:
  • Phone: 865-392-3400
  • Fax: 865-392-3449
Mailing address:
  • Phone: 865-392-3400
  • Fax: 865-392-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number23724
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number23724
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: