Healthcare Provider Details

I. General information

NPI: 1861029902
Provider Name (Legal Business Name): MARTINS EFOSA BAZUAYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 CORDATA PKWY STE B
BELLINGHAM WA
98226-8037
US

IV. Provider business mailing address

3315 BERRYWOOD DR STE 201
COLUMBIA MO
65201-6571
US

V. Phone/Fax

Practice location:
  • Phone: 360-752-5206
  • Fax:
Mailing address:
  • Phone: 573-884-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD70035452
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2023019463
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: