Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | G8728 | TX |
NPI | 1326087081 |
---|---|
Provider Name | Dr. Bruce G Martin |
First Address | San Antonio, TX 78229-3415 |
Second Address | San Antonio, TX 78229-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A67375 | (02) | TX |