Healthcare Provider Details

I. General information

NPI: 1386698603
Provider Name (Legal Business Name): MARTIN B GIANDONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S MAIN ST
YUMA CO
80759-3021
US

IV. Provider business mailing address

910 S MAIN ST
YUMA CO
80759-3021
US

V. Phone/Fax

Practice location:
  • Phone: 970-848-5405
  • Fax: 970-848-2348
Mailing address:
  • Phone: 970-848-5405
  • Fax: 970-848-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34911
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: