Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 04-17288 | KS |
N | 207RR0500X | Rheumatology | 04-17288 | KS |
NPI | 1043224207 |
---|---|
Provider Name | Dr. John D Martinez |
First Address | Kansas City, KS 66160 |
Second Address | Kansas City, KS 66160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 19/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100128060A | (05) | KS |
100128060C | (05) | KS |
D17426 | (02) | KS |