Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 523025 | WI |
N | 2081S0010X | Sports Medicine | 523025 | WI |
N | 213ES0000X | Sports Medicine | 523025 | WI |
N | 213ES0103X | Foot & Ankle Surgery | 523025 | WI |
NPI | 1184610685 |
---|---|
Provider Name | Garry M Martin |
First Address | Marshfield, WI 54449-3605 |
Second Address | Marshfield, WI 54449-3605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43204300 | (05) | WI |
T62688 | (02) | WI |