Provider Demographics
NPI:1053513408
Name:MARTIN, KIMBERLY B (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 S ALAMEDA ST
Mailing Address - Street 2:STE. 303
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1721
Mailing Address - Country:US
Mailing Address - Phone:361-853-3222
Mailing Address - Fax:361-561-2692
Practice Address - Street 1:5945 SARATOGA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4225
Practice Address - Country:US
Practice Address - Phone:361-853-3222
Practice Address - Fax:361-980-3619
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3869208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN3869OtherMEDICAL LICENSE
TX285350901Medicaid