Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | ME43734 | FL |
N | 208800000X | Urologist | ME43734 | FL |
NPI | 1356381834 |
---|---|
Provider Name | Laura Susan Martin |
First Address | Tallahassee, FL 32308-4513 |
Second Address | Tallahassee, FL 32308-4513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102212446A | (05) | GA |
102212446A | MEDICAID (01) | GA |
278957400 | (05) | FL |