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General NPI Number Information
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NPI Number | 1336120740
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Entity Type | Individual
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Provider Name | REG C MARTIN MD
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Gender | Male
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 1501 S COULTER ST
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City | AMARILLO
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State | TX
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Zip | 79106-1770
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Country | US
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Telephone | 806-354-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 801 S FILLMORE ST SUITE 410
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City | AMARILLO
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State | TX
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Zip | 79101-3537
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Country | US
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Telephone | 806-355-9595
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Fax | 806-353-1589
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | L4053
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | L4053
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License Number State | TX
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