Individual
GEORGE L MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 325, FORT WAYNE, IN 46845-1714
(260) 425-5400
(260) 425-5417
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01071495A
IN
208800000X
Urology Physician
37370
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000776371
ANTHEM
IN
05
—
201081540
—
IN
05
—
370244
—
AZ
01
—
P00869313
RAILROAD MEDICARE
AZ
Enumeration date
07/06/2006
Last updated
11/16/2022
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