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1730155516

NPI Code Detail

MEDICARE: DR. DEANDRA MARTIN MD

MEDICARE: DR. DEANDRA 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	207RN0300X	Nephrology Physician	J3350	TX
2	207R00000X	Internal Medicine Physician	J3350	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	:	1730155516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEANDRA MARTIN MD

Provider Business Mailing Address
First Line	:	7703 FLOYD CURL DR # MC7977
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3901
Country	:	US
Telephone Number	:	210-921-5620
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 S ZARZAMORA ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-5209
Country	:	US
Telephone Number	:	210-921-5620
Fax Number	:

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	05/21/2014

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Directions to “ DR. DEANDRA MARTIN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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