Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 43537 | AZ |
NPI | 1083878615 |
---|---|
Provider Name | Dr. Shelden L Martin |
First Address | Salt Lake City, UT 84127-1429 |
Second Address | Phoenix, AZ 85018-7227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 29/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
583819 | (05) | AZ |