Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | E-6115 | AR |
N | 2080P0207X | Pediatric Hematology-Oncologist | P7666 | TX |
NPI | 1184843419 |
---|---|
Provider Name | Andrew Arthur Martin |
First Address | Dallas, TX 75284-5347 |
Second Address | Springdale, AR 72762-0845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 21/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177405001 | (05) | AR |