Provider Demographics
NPI:1992749451
Name:MARTIN, FRANK GUICE (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:GUICE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720A MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2122
Mailing Address - Country:US
Mailing Address - Phone:228-354-0323
Mailing Address - Fax:228-354-9088
Practice Address - Street 1:1720A MEDICAL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2122
Practice Address - Country:US
Practice Address - Phone:228-354-0323
Practice Address - Fax:228-354-9088
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117204Medicaid
MS00117204Medicaid
MS020000284Medicare ID - Type Unspecified