Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH7418 | FL |
NPI | 1003926528 |
---|---|
Provider Name | Dr. Eduardo A. Martinez |
First Address | Coconut Grove, FL 33133-4634 |
Second Address | Coconut Grove, FL 33133-4634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55778 | BLUE CROSS/BLUE SHIELD ID (01) | FL |