Healthcare Provider Details

I. General information

NPI: 1649303694
Provider Name (Legal Business Name): ERICK G MARTELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP ST
FAIRBANKS AK
99701-5937
US

IV. Provider business mailing address

PO BOX 73720
FAIRBANKS AK
99707-3720
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3586
  • Fax: 907-374-7770
Mailing address:
  • Phone: 305-761-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11981
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number168881
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: