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Organization
PREVENTIAMED, PA
Active
Organization
PREVENTIAMED, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIETER ROBERT MARTIN M.D. (PRESIDENT)
(512) 308-6349
Entity
Organization
Contact information
Practice address
1250 S CAPITAL OF TEXAS HWY, BUILDING III, SUITE 400, WEST LAKE HILLS, TX 78746-6446
(512) 308-6349
Mailing address
1250 S CAPITAL OF TEXAS HWY, BUILDING III, SUITE 400, WEST LAKE HILLS, TX 78746-6446
(512) 308-6349
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182571301
—
TX
Enumeration date
04/17/2007
Last updated
10/23/2010
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