Healthcare Provider Details

I. General information

NPI: 1184157810
Provider Name (Legal Business Name): JON CURTIS MARTIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NW KINGS BLVD
CORVALLIS OR
97330-3900
US

IV. Provider business mailing address

2400 NW KINGS BLVD
CORVALLIS OR
97330-3900
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-2400
  • Fax:
Mailing address:
  • Phone: 541-757-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2051
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO222402
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: