Healthcare Provider Details

I. General information

NPI: 1831128198
Provider Name (Legal Business Name): ROBERT OTTO MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W 4TH ST
BAIRD TX
79504-5314
US

IV. Provider business mailing address

PO BOX 2435
ALBANY TX
76430-8020
US

V. Phone/Fax

Practice location:
  • Phone: 325-854-1365
  • Fax: 325-854-1409
Mailing address:
  • Phone: 325-893-4010
  • Fax: 325-893-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE4507
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: