Individual
DR. TAMMY L. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
233 CLARKSON RD, ELLISVILLE, MO 63011-2219
(636) 256-8644
Mailing address
625 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8253
(314) 993-5454
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R9H77
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00333756
RR MEDICARE
MO
01
—
P00700283
RR MEDICARE
MO
Enumeration date
07/20/2006
Last updated
04/17/2020
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