Healthcare Provider Details

I. General information

NPI: 1871529453
Provider Name (Legal Business Name): MARTIN V THAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR STE 201
AUSTIN TX
78758-5388
US

IV. Provider business mailing address

PO BOX 117475
CARROLLTON TX
75011-7475
US

V. Phone/Fax

Practice location:
  • Phone: 210-495-7246
  • Fax: 210-495-7245
Mailing address:
  • Phone: 210-495-7246
  • Fax: 210-495-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberM3402
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberM3402
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM3402
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: