Individual
MRS. DIANNA C MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
302 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1032
(512) 509-0200
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10339
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017RP
BLUE CROSS
—
05
—
8931917
—
NC
Enumeration date
08/24/2006
Last updated
11/02/2020
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