Provider Demographics
NPI:1104883693
Name:MARTIN, ANDREW J (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2316 ELLA LEE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-6309
Mailing Address - Country:US
Mailing Address - Phone:979-429-4322
Mailing Address - Fax:903-209-2974
Practice Address - Street 1:4301 W MARKHAM ST # 556
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-296-1095
Practice Address - Fax:501-526-5919
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM23932085R0204X, 2085R0202X
AZ660802085R0202X
PAMD4664582085R0202X
NJ25MA115138002085R0202X
ARE-140512085R0202X, 2085R0204X
SC268662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84714SOtherBLUE CROSS BLUE SHIELD TX
TXI07945Medicare UPIN
TX8G3185Medicare ID - Type Unspecified