Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 00282 | WV |
NPI | 1437119856 |
---|---|
Provider Name | Dr. Martin M Mrozek |
First Address | Fayetteville, WV 25840-0957 |
Second Address | Fayetteville, WV 25840-0957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 11/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001721891 | MOUNTAIN STATE BC BS (01) | WV |
0099788000 | (05) | WV |
223203 | ADVANTRA (01) | WV |
353171 | ALLIANCE PPO (01) | WV |
4281890001 | DMERC (01) | WV |
P00252983 | RR MEDICARE (01) | WV |
U45973 | (02) | WV |