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General NPI Number Information
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NPI Number | 1184626533
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Entity Type | Individual
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Provider Name | C MARTIN PERSONS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 4625 BOAT CLUB RD SUITE 253
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City | FORT WORTH
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State | TX
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Zip | 76135-7022
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Country | US
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Telephone | 817-399-1622
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Fax | 817-540-0759
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Provider Business Mailing Address
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Address Line | 4625 BOAT CLUB RD SUITE 253
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City | FORT WORTH
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State | TX
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Zip | 76135-7022
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Country | US
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Telephone | 817-399-1622
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Fax | 817-540-0759
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | F4368
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License Number State | TX
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