Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G56034 | CA |
NPI | 1033293261 |
---|---|
Provider Name | Wayne Hamilton Martin |
First Address | Diamond Bar, CA 91765-4171 |
Second Address | Diamond Bar, CA 91765-4171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 09/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G560342 | (05) | CA |
A93418 | (02) | CA |