Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 07892 | MS |
NPI | 1144209727 |
---|---|
Provider Name | Dr. Martin M Pomphrey JR. |
First Address | Starkville, MS 39759-2163 |
Second Address | Starkville, MS 39759-2155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00016363 | (05) | MS |
D00762 | (02) | MS |