MEDICARE: THOMAS O MARTIN 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	208D00000X	General Practice Physician	14840	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4024	OTHER	NE	MIDLAND'S CHOICE
2	35349	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1174625875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS O MARTIN MD

Provider Business Mailing Address
First Line	:	8055 O ST
Second Line	:	STE 300
City	:	LINCOLN
State	:	NE
Zip	:	68510-2580
Country	:	US
Telephone Number	:	402-421-0896
Fax Number	:	402-421-0945

Provider Business Practice Location Address
First Line	:	5000 N 26TH ST
Second Line	:	STE 300
City	:	LINCOLN
State	:	NE
Zip	:	68521-4749
Country	:	US
Telephone Number	:	402-435-2060
Fax Number	:	402-435-2046

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	02/27/2008

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Directions to “ THOMAS O MARTIN MD” Practice Location

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