Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | R75756 | AZ |
Y | 208000000X | Pediatrician | R75756 | AZ |
NPI | 1003264581 |
---|---|
Provider Name | Martin Demant |
First Address | Tucson, AZ 85719-4939 |
Second Address | Tucson, AZ 85724-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2016 |
Last Update Date | 28/05/2019 |