Provider Demographics
NPI:1932179991
Name:MARTIN, ADRIANE (DO)
Entity type:Individual
Prefix:DR
First Name:ADRIANE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MALVERN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7759
Mailing Address - Country:US
Mailing Address - Phone:501-623-9300
Mailing Address - Fax:501-623-9305
Practice Address - Street 1:1900 MALVERN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7759
Practice Address - Country:US
Practice Address - Phone:501-623-9300
Practice Address - Fax:501-623-9305
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1380208600000X
ARE5726208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166235502Medicaid
AR178197003Medicaid
TX8D8794Medicare ID - Type Unspecified
TX166235502Medicaid
TXI07884Medicare UPIN