Healthcare Provider Details

I. General information

NPI: 1144333055
Provider Name (Legal Business Name): THOMAS E MARTENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18817 HEATHERWILDE BLVD STE 150
PFLUGERVILLE TX
78660-7866
US

IV. Provider business mailing address

18817 N HEATHERWILDE BLVD STE 150
PFLUGERVILLE TX
78660-1750
US

V. Phone/Fax

Practice location:
  • Phone: 512-523-4878
  • Fax: 512-870-9770
Mailing address:
  • Phone: 512-523-4878
  • Fax: 512-870-9770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberL8125
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: