Healthcare Provider Details

I. General information

NPI: 1356341408
Provider Name (Legal Business Name): GORDON HUNTER MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

333 N TEXAS AVE SUITE 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 TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJ5107
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberJ5107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: