Healthcare Provider Details

I. General information

NPI: 1710983994
Provider Name (Legal Business Name): JOSEPH E MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

7707 EWING HALSELL DR STE 103
SAN ANTONIO TX
78229-4040
US

IV. Provider business mailing address

7707 EWING HALSELL DR STE 103
SAN ANTONIO TX
78229-4040
US

V. Phone/Fax

Practice location:
  • Phone: 210-692-0577
  • Fax: 210-692-1210
Mailing address:
  • Phone: 210-692-0577
  • Fax: 210-692-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberD0959
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD0959
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: