Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 22004 | AZ |
N | 207XS0117X | Orthopaedic Spine Surgeon | G88322 | CA |
NPI | 1053425173 |
---|---|
Provider Name | Mr. Jeffrey Alan Martin |
First Address | Phoenix, AZ 85016-2147 |
Second Address | Phoenix, AZ 85016-2147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 26/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42814503 | (05) | AZ |
G69314 | (02) | |
GR0070300 | MEDI-CAL GROUP (01) | CA |
ZZZZ11111Z | GROUP (01) | CA |