Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | E5411 | TX |
NPI | 1043268907 |
---|---|
Provider Name | Dr. Martin Alan Menter |
First Address | Dallas, TX 75246-1615 |
Second Address | Dallas, TX 75246-1615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 27/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70012312 | MEDICARE RAILROAD (01) | TX |
B24857 | (02) | TX |