MEDICARE: MR. CHARLES R 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	207RP1001X	Pulmonary Disease Physician	H5255	TX

General Provider Information

NPI Number	:	1780661892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES R MARTIN MD

Provider Business Mailing Address
First Line	:	703 E MARSHALL AVE
Second Line	:	STE 3008
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5500
Country	:	US
Telephone Number	:	903-315-2740
Fax Number	:	903-315-2742

Provider Business Practice Location Address
First Line	:	703 E MARSHALL AVE
Second Line	:	STE 3008
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5500
Country	:	US
Telephone Number	:	903-315-2740
Fax Number	:	903-315-2742

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	12/30/2011

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Directions to “ MR. CHARLES R MARTIN MD” Practice Location

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