Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | N2187 | TX |
N | 207R00000X | Internist | N2187 | TX |
N | 111NI0900X | Internist | N2187 | TX |
NPI | 1003016742 |
---|---|
Provider Name | Benjamin Seth Martinez |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 03/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N2187 | MEDICAL LICENSE (01) | TX |