Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 24336 | TN |
NPI | 1346240777 |
---|---|
Provider Name | Dr. Martin I Herman |
First Address | Bartlett, TN 38133-4032 |
Second Address | Memphis, TN 38103-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 27/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C48053 | (02) | TN |