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NPI Code Detail

MEDICARE: MR. RANDALL STUART MARTZ PAC

MEDICARE: MR. RANDALL STUART MARTZ PAC
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
1363AM0700XMedical Physician AssistantPA00020TX

General Provider Information

NPI Number : 1972598456
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL STUART MARTZ PAC
Provider Business Mailing Address
First Line : 195 OAKVIEW RD
Second Line :
City : GAINESVILLE
State : TX
Zip : 76240-6642
Country : US
Telephone Number : 940-612-1662
Fax Number :
Provider Business Practice Location Address
First Line : 1512 TEASLEY LN
Second Line :
City : DENTON
State : TX
Zip : 76205-7282
Country : US
Telephone Number : 940-566-5010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 07/12/2007

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Directions to “ MR. RANDALL STUART MARTZ PAC” Practice Location

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