Individual
DR. BRUCE D MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12461 TIMBERLAND BLVD, SUITE 309, FORT WORTH, TX 76244-5213
(817) 741-5437
(817) 977-5439
Mailing address
12461 TIMBERLAND BLVD, SUITE 309, FORT WORTH, TX 76092
(817) 741-5437
(888) 400-5412
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L8824
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U87Z
BCBSTX GRP PIN
TX
05
—
165586203
—
TX
01
—
1881820595
GROUP NPI NUMBER
TX
05
—
205573301
—
TX
01
—
2619123
UHC PIN
TX
01
—
7340635
AETNA PIN
TX
01
—
8A5662
BCBSTX PIN
TX
01
—
8BQ027
BCBS
TX
01
—
MARBI09084
CCHIP PIN
TX
Enumeration date
10/16/2006
Last updated
01/18/2013
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