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NPI Code Detail

MEDICARE: TERESA D MARTIN PA-C

MEDICARE: TERESA D MARTIN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant22297CA
2363A00000XPhysician AssistantPA1792NV
3363A00000XPhysician Assistant35362MT
4363A00000XPhysician AssistantPA12432TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA12432OTHERTXPA LICENSE

General Provider Information

NPI Number : 1104890672
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA D MARTIN PA-C
Provider Business Mailing Address
First Line : 1209 HIGHKNOLL LANE
Second Line :
City : GEORGETOWN
State : TX
Zip : 78628-1015
Country : US
Telephone Number : 904-468-0111
Fax Number :
Provider Business Practice Location Address
First Line : 1855 GATTIS SCHOOL RD
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-7428
Country : US
Telephone Number : 512-238-6268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 06/20/2022

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Directions to “ TERESA D MARTIN PA-C” Practice Location

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