Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G24101 | CA |
NPI | 1023121969 |
---|---|
Provider Name | Dr. John J Martin |
First Address | San Diego, CA 92163-3865 |
Second Address | San Diego, CA 92103-2116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 02/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BN261X | MEDICARE PTAN FOR GHP (01) | CA |