Basic Information
Provider Information
NPI: 1083651681
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTIN
FirstName: LUTHER
MiddleName: CHATMAN
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 201 E ARIZONA AVE
Address2:  
City: SWEETWATER
State: TX
PostalCode: 795567119
CountryCode: US
TelephoneNumber: 3252358641
FaxNumber: 3252355925
Practice Location
Address1: 201 E ARIZONA AVE
Address2:  
City: SWEETWATER
State: TX
PostalCode: 795567119
CountryCode: US
TelephoneNumber: 3252358641
FaxNumber: 3252355925
Other Information
ProviderEnumerationDate: 06/01/2006
LastUpdateDate: 02/20/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XE9795TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
1227423-0305TX MEDICAID


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