Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC2052 | TX |
NPI | 1558305037 |
---|---|
Provider Name | Dr. Clem C Martin |
First Address | Bonham, TX 75418-2628 |
Second Address | Bonham, TX 75418-2628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0068EV | BCBS (01) | TX |
8114624 | BLUE LIKE NUMBER (01) | TX |
8A4830 | BCBS NUMBER (01) | TX |
P00967449 | MEDICARE RAILROAD CARRIER (01) | TX |
T14624 | (02) | TX |