Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 13285 | AL |
NPI | 1063450211 |
---|---|
Provider Name | Jose E. Martinez |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604-1512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 16/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000082786 | (05) | AL |
00115509 | (05) | MS |
12-10007 | UNITED HEALTH CARE (01) | AL |
1523551 | (05) | LA |
255879300 | (05) | FL |
51082786 | BLUE CROSS (01) | AL |
E75291 | (02) |