Martin a. Derusha, Jr., D.O,, P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

K0454 Issued in TX

Legal business name

MARTIN A. DERUSHA, JR., D.O,, P.A.

Practice address

1510 Pennsylvania Ave
Fort Worth, TX 76104-2027

Phone

(817) 882-0984

NPI assigned

Jan 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Martin Allyn Derusha Jr., D.O.

Title

Owner

Phone

(817) 882-0984

Specialties & licenses 1

Addresses

Other names 1

• Martin DeRusha, Jr., D.O. Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497801211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042027",
            "telephone_number": "817-882-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042027",
            "telephone_number": "817-882-0984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN A. DERUSHA, JR., D.O,, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DERUSHA",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "ALLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-882-0984",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K0454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin DeRusha, Jr., D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nicole Marshall, LCSW
• Renee Alexandra Marshall, PA-C
• Robert Larry Marshall, MD
• Victoria Aleshia Marshall
• Alfredo L. Marti, M.D.
• Alaina Martin, OTR
• Angela Martin, SLP-ASSISTANT
• Anna Martin, CTRS
• Antonio Eduardo Martin, M.D.
• Baqi S. Martin, LCSW

• Family Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.