MEDICARE: DR. DOUGLAS 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	207Y00000X	Otolaryngology Physician	F6908	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

General Provider Information

NPI Number	:	1225031305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS MARTIN MD

Provider Business Mailing Address
First Line	:	203 W MAJESTIC OAK
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2028
Country	:	US
Telephone Number	:	512-863-7391
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 UNIVERSITY BLVD
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1032
Country	:	US
Telephone Number	:	512-509-0200
Fax Number	:	512-509-0253

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/07/2013

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