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General NPI Number Information
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NPI Number | 1730469693
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Entity Type | Organization
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Legal Business Name | MARTIN EAR NOSE & THROAT CLINIC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 37 DOCTORS PARK SUITE 1
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4956
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Country | US
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Telephone | 573-332-7000
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Fax | 573-332-7005
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Provider Business Mailing Address
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Address Line | 37 DOCTORS PARK SUITE 1
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4956
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Country | US
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Telephone | 573-332-7000
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Fax | 573-332-7005
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. RICHARD A MARTIN
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Credential | MD
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Telephone | 573-335-6163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | R8494
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License Number State | MO
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