MEDICARE: C MARTIN PERSONS M.D.

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	207X00000X	Orthopaedic Surgery Physician	F4368	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MDF4368	OTHER	TX	WORKERS COMP
2	4080053	OTHER	TX	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184626533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C MARTIN PERSONS M.D.

Provider Business Mailing Address
First Line	:	4625 BOAT CLUB RD
Second Line	:	SUITE 253
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7022
Country	:	US
Telephone Number	:	817-399-1622
Fax Number	:	817-540-0759

Provider Business Practice Location Address
First Line	:	4625 BOAT CLUB RD
Second Line	:	SUITE 253
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7022
Country	:	US
Telephone Number	:	817-399-1622
Fax Number	:	817-540-0759

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/11/2013

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