Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | P6456 | TX |
NPI | 1003127093 |
---|---|
Provider Name | Dr. Armando Leonel Martinez |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 13/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8DT524 | BCBS (01) | TX |