=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578932109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR TIM MARTIN MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2015
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2110 N WILLIS ST STE B
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79603-4359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-232-8675
-----------------------------------------------------
Fax | 325-899-3418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2110 N WILLIS ST STE B
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79603-4359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-232-8675
-----------------------------------------------------
Fax | 325-899-3418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | TIM MARTIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 325-232-8675
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number | K2958
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------