Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35068144 | OH |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35.068144 | OH |
NPI | 1174516371 |
---|---|
Provider Name | Robert A. Martin |
First Address | Columbus, OH 43213-4441 |
Second Address | Columbus, OH 43213-4441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 22/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000349495 | ANTHEM (01) | OH |
0133948 | (05) | OH |
2514292 | BCMH (01) | OH |
4490238 | AETNA (01) | OH |
F77028 | (02) | OH |