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Individual

FREDERICK A MARTIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1958 W STATE ST, BRISTOL, TN 37620-1940
(423) 574-7575
(423) 574-7576
Mailing address
1958 W STATE ST, BRISTOL, TN 37620-1940
(423) 574-7575
(423) 574-7576

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD35685
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010178835
VA
01
179765
ANTHEM PROVIER #
VA
05
3707101
TN
01
4107515
BCBS TN
TN
01
4338099
AETNA#
01
62172092012
JOHN DEERE #
TN
Enumeration date
09/20/2005
Last updated
05/31/2016
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