Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 26589 | TN |
Y | 208600000X | Surgeon | 26589 | TN |
N | 2082S0105X | Plastic Hand Surgeon | 26589 | TN |
NPI | 1053317149 |
---|---|
Provider Name | David S Martin |
First Address | Murfreesboro, TN 37129 |
Second Address | Murfreesboro, TN 37129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 12/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1340038 | UNITED HEALTHCARE (01) | TN |
3012386 | BLUE CROSS BLUE SHIELD (01) | TN |
3090992 | (05) | TN |
G03004 | (02) | TN |