Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 6168 | TX |
NPI | 1417174137 |
---|---|
Provider Name | Dr. Billie Martin |
First Address | Bellaire, TX 77401-3521 |
Second Address | Bellaire, TX 77401-3521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |