Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301093015 | MI |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 51816 | SC |
NPI | 1891957940 |
---|---|
Provider Name | Eduardo Miguel Martinez |
First Address | Georgetown, SC 29442-4203 |
Second Address | Myrtle Beach, SC 29588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 27/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
518167 | (05) | SC |