Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 18901 | TX |
NPI | 1063530772 |
---|---|
Provider Name | Dr. James Edward Martinez |
First Address | Cypress, TX 77429-2419 |
Second Address | Cypress, TX 77429-2419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |