Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | ME 27021 | FL |
NPI | 1194827329 |
---|---|
Provider Name | Walter C Martinez |
First Address | West Palm Beach, FL 33407 |
Second Address | West Palm Beach, FL 33407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 04/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D55832 | (02) | FL |