Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 22176 | NE |
NPI | 1003926957 |
---|---|
Provider Name | Todd D Martin |
First Address | Lincoln, NE 68516-4714 |
Second Address | Lincoln, NE 68516-4714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 07/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31725 | BLUE CROSS BLUE SHIELD (01) | NE |
470352176-13 | (05) | NE |
H61595 | (02) |