Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 036114207 | IL |
NPI | 1053417238 |
---|---|
Provider Name | Eduardo Martinez-Barrios |
First Address | Belleville, IL 62226-5368 |
Second Address | Belleville, IL 62226-5366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 10/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036114207 | (05) | IL |
E58084 | (02) | IL |