Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 51010980501 | UT |
NPI | 1023013794 |
---|---|
Provider Name | Dr. William Woodrow Martin |
First Address | Logan, UT 84341-2450 |
Second Address | Logan, UT 84341-2450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 19/12/2012 |