Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 34002480 | OH |
N | 207Q00000X | Family Doctor | 34002480 | OH |
NPI | 1043273303 |
---|---|
Provider Name | Paul Martin |
First Address | Novelty, OH 44072-9541 |
Second Address | Broadview Heights, OH 44147-2811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E00619 | (02) |