Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 30487 | AZ |
NPI | 1346662939 |
---|---|
Provider Name | Dr. Duane Martin |
First Address | Gilbert, AZ 85296-8653 |
Second Address | Gilbert, AZ 85296-8653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2014 |
Last Update Date | 15/01/2014 |