Provider Demographics
NPI:1871529453
Name:THAI, MARTIN V (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:V
Last Name:THAI
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:PO BOX 117475
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-7475
Mailing Address - Country:US
Mailing Address - Phone:210-495-7246
Mailing Address - Fax:210-495-7245
Practice Address - Street 1:2200 PARK BEND DR STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5388
Practice Address - Country:US
Practice Address - Phone:210-495-7246
Practice Address - Fax:210-495-7245
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3402207L00000X, 207LP2900X, 208VP0014X
MO2003005883208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7893841OtherAETNA
MO36986011OtherBCBS OF KC
TXP00924214OtherRR MEDICARE
TXP00329857OtherRAILROAD
MO033888Medicaid
MO201411501Medicaid
TX201421902Medicaid
TX8CB638OtherBCBS
MO200421190BMedicaid
KS200421190AMedicaid
TX8CB638OtherBCBS
KS200421190AMedicaid
MO200421190BMedicaid
KSL47E647BMedicare PIN