# DERLIS MARTINO MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063587269
- **Authorized official:** DERLIS MARTINO MD (PRESIDENT)
- **Authorized official phone:** (501) 223-2860

## Contact information

- **Practice address:** 9601 LILE DR, SUITE 650, LITTLE ROCK, AR 72205-6321
- **Practice address phone:** (501) 223-2860
- **Practice address fax:** (501) 223-2258
- **Mailing address:** 9601 LILE DR, SUITE 650, LITTLE ROCK, AR 72205-6321
- **Mailing address phone:** (501) 223-2860
- **Mailing address fax:** (501) 223-2258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 10/09/2007