Healthcare Provider Details

I. General information

NPI: 1902155864
Provider Name (Legal Business Name): MARTIN L YAMZON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-3000
  • Fax: 210-539-2075
Mailing address:
  • Phone: 210-916-3000
  • Fax: 210-539-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7658246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: