Organization
ANESTHESIA ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL P. MARTIN D.O. (PRESIDENT)
(817) 529-1144
Entity
Organization
Contact information
Practice address
4916 OVERTON PLZ, FORT WORTH, TX 76109-4415
(817) 334-0530
(817) 334-0235
Mailing address
4916 OVERTON PLZ, FORT WORTH, TX 76109-4415
(817) 334-0530
(817) 334-0235
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110809401
—
TX
05
—
110809403
—
TX
Enumeration date
09/22/2005
Last updated
10/16/2009
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