Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | L8826 | TX |
NPI | 1194813543 |
---|---|
Provider Name | Paul T Martinelli |
First Address | Plano, TX 75093-5371 |
Second Address | Plano, TX 75093-5371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 26/09/2012 |