MEDICARE: JUSTIN L 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	207RI0011X	Interventional Cardiology Physician	L2446	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184624306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN L MARTIN MD

Provider Business Mailing Address
First Line	:	1300 W TERRELL AVE STE 500
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-2810
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:	817-252-5060

Provider Business Practice Location Address
First Line	:	1300 W TERRELL AVE STE 500
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-2810
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:	817-252-5060

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	09/15/2014

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Directions to “ JUSTIN L MARTIN MD” Practice Location

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