Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | Q4196 | TX |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | Q4196 | TX |
NPI | 1215227566 |
---|---|
Provider Name | Dr. Robert Benjamin Martin |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2011 |
Last Update Date | 21/06/2019 |