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General NPI Number Information
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NPI Number | 1679545487
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Entity Type | Individual
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Provider Name | GERARD L MARTEN-ELLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 2301 S CLEAR CREEK RD SUITE 116
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City | KILLEEN
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State | TX
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Zip | 76549-4143
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Country | US
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Telephone | 254-526-5505
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Fax | 254-526-4313
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Provider Business Mailing Address
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Address Line | 2301 S CLEAR CREEK RD SUITE 116
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City | KILLEEN
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State | TX
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Zip | 76549-4143
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Country | US
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Telephone | 254-526-5505
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Fax | 254-526-4313
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G6970
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License Number State | TX
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