Provider Demographics
NPI:1174625875
Name:MARTIN, THOMAS O (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:O
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 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:5000 N 26TH ST
Practice Address - Street 2:STE 300
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4749
Practice Address - Country:US
Practice Address - Phone:402-435-2060
Practice Address - Fax:402-435-2046
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE14840208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4024OtherMIDLAND'S CHOICE
NE35349OtherBCBS
NE35349OtherBCBS
NE4024OtherMIDLAND'S CHOICE