Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 200500357 | NC |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 200500357 | NC |
NPI | 1093774747 |
---|---|
Provider Name | Lewis Paul Martin |
First Address | Wilson, NC 27895-3148 |
Second Address | Wilson, NC 27893 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 25/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H65780 | (02) | |
S9D1142 | (05) | NC |