Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DD4257 | NM |
N | 213EG0000X | General Practice | DD4257 | NM |
Y | 1223X0400X | Orthodontists | 28983 | TX |
NPI | 1063807873 |
---|---|
Provider Name | Dr. Camaron Leigh Martin |
First Address | Fair Oaks Ranch, TX 78015-4821 |
Second Address | El Paso, TX 79915-1838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 30/03/2015 |