Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | LL28073 | SC |
Y | 207X00000X | Orthopaedic Surgeon | 2010-01328 | NC |
NPI | 1649356072 |
---|---|
Provider Name | Steve Marshall Martin JR. |
First Address | Charlotte, NC 28260-0447 |
Second Address | Charlotte, NC 28211-1064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 25/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159P8 | BCBS (01) | NC |
1649356072 | (05) | NC |
5915204 | (05) | NC |