Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MD00038721 | WA |
Y | 208000000X | Pediatrician | MD00038721 | WA |
NPI | 1104804442 |
---|---|
Provider Name | Dr. Judith Martin |
First Address | Spokane, WA 99204-2302 |
Second Address | Spokane, WA 99204-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 29/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1112051 | (05) | WA |
E04549 | (02) |