Provider Demographics
NPI:1043268907
Name:MENTER, MARTIN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ALAN
Last Name:MENTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 JUNIUS ST
Mailing Address - Street 2:SUITE 145
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1615
Mailing Address - Country:US
Mailing Address - Phone:972-386-7546
Mailing Address - Fax:972-701-8008
Practice Address - Street 1:3900 JUNIUS ST
Practice Address - Street 2:SUITE 145
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1615
Practice Address - Country:US
Practice Address - Phone:972-386-7546
Practice Address - Fax:972-701-8008
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5411207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70012312OtherMEDICARE RAILROAD
TXB24857Medicare UPIN
TX84493KMedicare PIN