Provider Demographics
NPI:1386698603
Name:GIANDONI, MARTIN B (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:B
Last Name:GIANDONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:910 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:CO
Mailing Address - Zip Code:80759-3021
Mailing Address - Country:US
Mailing Address - Phone:970-848-5405
Mailing Address - Fax:970-848-2348
Practice Address - Street 1:910 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:CO
Practice Address - Zip Code:80759-3021
Practice Address - Country:US
Practice Address - Phone:970-848-5405
Practice Address - Fax:970-848-2348
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO34911207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG22272Medicare UPIN