Individual
DR. DAVID R. MARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 556-7708
(573) 893-8061
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 556-7708
(573) 893-8061
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
R7197
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040007612
MEDICARE RAILROAD
MO
01
—
172463
HEALTHLINK
MO
05
—
201039930
—
MO
01
—
5350
BCBS
MO
01
—
990001391
MCR GROUP
MO
01
—
CP9089
RR GROUP
MO
Enumeration date
12/22/2005
Last updated
08/07/2008
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