Individual
DALLAS B MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1106 SKYTOP CIR, CHARLESTON, WV 25314-2222
(304) 610-3704
Mailing address
1106 SKYTOP CIR, CHARLESTON, WV 25314-2222
(304) 610-3704
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1048
WV
207Q00000X
Family Medicine Physician
Primary
1048
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0042041000
—
WV
Enumeration date
07/17/2006
Last updated
11/17/2010
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