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General NPI Number Information
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NPI Number | 1699085563
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Entity Type | Organization
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Legal Business Name | CR MARTIN M D P A
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 703 E MARSHALL AVE SUITE 3008
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City | LONGVIEW
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State | TX
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Zip | 75601-5500
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Country | US
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Telephone | 903-315-2740
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Fax | 903-315-2742
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Provider Business Mailing Address
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Address Line | 703 E MARSHALL AVE STE 3008
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City | LONGVIEW
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State | TX
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Zip | 75601-5500
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Country | US
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Telephone | 903-315-2740
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Fax | 903-315-2742
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES R. MARTIN
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Credential | M.D.
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Telephone | 903-315-2740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | H5255
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | H5255
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License Number State | TX
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