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General NPI Number Information
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NPI Number | 1447572599
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Entity Type | Organization
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Legal Business Name | R. MARK MARTIN, MD PA
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 2506 CROCKETT DR
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City | BROWNWOOD
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State | TX
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Zip | 76801-5900
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Country | US
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Telephone | 325-643-3656
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Fax | 325-646-8484
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Provider Business Mailing Address
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Address Line | 2506 CROCKETT DR
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City | BROWNWOOD
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State | TX
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Zip | 76801-5900
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Country | US
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Telephone | 325-643-3656
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Fax | 325-646-8484
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Authorized Official
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Title or Position | OWNER
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Name | RAY MARTIN
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Credential | MD
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Telephone | 325-643-3656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | F4248
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License Number State | TX
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