Individual
DR. ROBERT TATE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1811 E BERT KOUNS INDUSTRIAL LOOP # 210, SHREVEPORT, LA 71105
(318) 212-3858
(318) 212-3958
Mailing address
1811 E BERT KOUNS INDUSTRIAL LOOP # 210, SHREVEPORT, LA 71105-5740
(318) 212-3858
(318) 212-3958
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
L#021109
LA
207RC0000X
Cardiovascular Disease Physician
Primary
MD.021109
LA
207RI0011X
Interventional Cardiology Physician
L#021109
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057726401
—
TX
01
—
060053256
RAILROAD MEDICARE
LA
05
—
1017159
—
LA
05
—
132212001
—
AR
Enumeration date
10/25/2005
Last updated
07/08/2021
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