Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2016-00772 | NC |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 63061 | TN |
NPI | 1366763344 |
---|---|
Provider Name | John Ryan Martin |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-5081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2010 |
Last Update Date | 09/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366763344 | (05) | NC |
NC2740 | (05) | SC |