Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 10629 | MS |
NPI | 1326073404 |
---|---|
Provider Name | Dr. Rick Martin |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 14/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00015809 | (05) | MS |
08103071 | UP MEDICAID GROUP PROV# (01) | MS |
09014712 | (05) | MS |
160039616 | RR MEDICARE NUMBER (01) | MS |
512G700003 | UP MEDICARE GROUP PROV# (01) | MS |
512I160012 | MEDICARE PTAN (01) | MS |
B30322 | (02) | MS |