Healthcare Provider Details

I. General information

NPI: 1659304566
Provider Name (Legal Business Name): GORDON H MARTIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N TEXAS AVE STE 4200
WEBSTER TX
77598-4966
US

IV. Provider business mailing address

333 N TEXAS AVE STE 4200
WEBSTER TX
77598-4966
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-3142
  • Fax: 281-332-7568
Mailing address:
  • Phone: 281-332-3142
  • Fax: 281-332-7568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ5107
License Number StateTX

VIII. Authorized Official

Name: GORDON H MARTIN
Title or Position: PRESIDENT
Credential: MD
Phone: 281-332-3142