Provider Demographics
NPI:1578627337
Name:TAUBMAN, MARTIN R (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:R
Last Name:TAUBMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 3RD AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5639
Mailing Address - Country:US
Mailing Address - Phone:619-298-1733
Mailing Address - Fax:619-294-9604
Practice Address - Street 1:3330 3RD AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5639
Practice Address - Country:US
Practice Address - Phone:619-298-1733
Practice Address - Fax:619-294-9604
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2237213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4134698OtherAETNA
CA000E22370Medicaid
CAZZZ07925ZOtherBLUE SHIELD OF CALIFORNIA
CA000E22370Medicaid
CAZZZ07925ZOtherBLUE SHIELD OF CALIFORNIA