MEDICARE: REBECCA M MARTIN D.O.

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	207P00000X	Emergency Medicine Physician	02001840A	IN

General Provider Information

NPI Number	:	1801874417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA M MARTIN D.O.

Provider Business Mailing Address
First Line	:	10906 W SYCAMORE HILLS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9334
Country	:	US
Telephone Number	:	260-625-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	10906 W SYCAMORE HILLS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9334
Country	:	US
Telephone Number	:	260-625-5540
Fax Number	:

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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