1073991147 NPI number — MARTIN CLAUDE DAVID LICENSED DME PROVIDE

Table of content: MARTIN CLAUDE DAVID LICENSED DME PROVIDE (NPI 1073991147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073991147 NPI number — MARTIN CLAUDE DAVID LICENSED DME PROVIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVID
Provider First Name:
MARTIN
Provider Middle Name:
CLAUDE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICENSED DME PROVIDE
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073991147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15029 N THOMPSON PEAK PKWY
Provider Second Line Business Mailing Address:
B111-580
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-2217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-653-1378
Provider Business Mailing Address Fax Number:
602-532-7628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15029 N THOMPSON PEAK PKWY
Provider Second Line Business Practice Location Address:
B111-580
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-2217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-653-1378
Provider Business Practice Location Address Fax Number:
602-532-7628
Provider Enumeration Date:
05/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X , with the licence number:  CR12 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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