Provider Demographics
NPI:1669678595
Name:MARTIN, GARRY MICHAEL II (MD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:MICHAEL
Last Name:MARTIN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8756
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:STE 530
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:913-932-0288
Practice Address - Fax:816-932-9868
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2016-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KSUNKNOWN208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery