Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A73631 | CA |
NPI | 1023196862 |
---|---|
Provider Name | Paul A. Martin |
First Address | Oakland, CA 94612-3466 |
Second Address | Vallejo, CA 94589-2441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A736310 | (05) | CA |
I14864 | (02) |