MEDICARE: ERLING D MARTINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5150	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13280	OTHER	ND	NCHS MCVILLE BLUE CROSS
2	21127	OTHER	ND	LAKOTA HEALTH CTR BLUE CR

General Provider Information

NPI Number	:	1558401554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERLING D MARTINSON

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:	108 N MAIN STR
City	:	MCVILLE
State	:	ND
Zip	:	58254
Country	:	US
Telephone Number	:	701-322-4347
Fax Number	:	701-322-2250

Provider Business Practice Location Address
First Line	:	108 N MAIN STREET
Second Line	:
City	:	MCVILLE
State	:	ND
Zip	:	58254
Country	:	US
Telephone Number	:	701-322-4347
Fax Number	:	701-322-2250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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Directions to “ ERLING D MARTINSON ” Practice Location

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