Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | L8125 | TX |
NPI | 1144333055 |
---|---|
Provider Name | Dr. Thomas E Martens |
First Address | Pflugerville, TX 78660-1750 |
Second Address | Pflugerville, TX 78660-7866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 16/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8U7931 | BLUE CROSS BLUE SHIELD (01) | TX |
H07034 | (02) | TX |