MEDICARE: MARTIN DOMINIC DEVINE MD

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
1	207Q00000X	Family Medicine Physician	200518	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	9077680	OTHER	CIGNA HEALTH PLAN
2	42367	OTHER	FALLON COMMUNITY HEALTH P
3	042472266	OTHER	THREE RIVERS
4	042472266	OTHER	PRIVATE HEALTHCARE SYSTEM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	J19558	OTHER	BLUE SHIELD INDEMNITY
7	J19558	OTHER	BLUE SHIELD HMO BLUE
8	31001	OTHER	HEALTHY START
9	2031301	OTHER	FIRST HEALTH
10	31001	OTHER	CHILDRENS MEDICAL SECURIT
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	5478684	OTHER	AETNA US HEALTHCARE
13	J19558	OTHER	BLUE CARE ELECT
14	042472266	OTHER	ONE HEALTH PLAN
15	155190	OTHER	TUFTS HEALTH PLAN
16	71937	OTHER	HARVARD PILGRIM HEALTHCAR
17	786721	OTHER	MVP HEALTH CARE

General Provider Information

NPI Number	:	1134180425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN DOMINIC DEVINE MD

Provider Business Mailing Address
First Line	:	1107 W POPLAR AVE
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-5839
Country	:	US
Telephone Number	:	877-960-3426
Fax Number	:	559-793-3567

Provider Business Practice Location Address
First Line	:	1107 W POPLAR AVE
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-5839
Country	:	US
Telephone Number	:	877-960-3426
Fax Number	:	559-793-3567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	01/31/2025

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1107 W POPLAR AVE
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1881645265 — CHRISTOPHER GILLESPIE M.D.
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1023068525 — DR. MARIA S. HERNANDEZ MD
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Directions to “ MARTIN DOMINIC DEVINE MD” Practice Location

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