Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | NC |
NPI | 1043204720 |
---|---|
Provider Name | Dr. Louis Martinez |
First Address | Apo, AE 09464-0801 |
Second Address | Apo, AE 09464-8730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 08/07/2007 |