Healthcare Provider Details

I. General information

NPI: 1053408336
Provider Name (Legal Business Name): WALBURGA S MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WALBURGA STEPHANIE MARTIN MD

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DALE AVE
BENTON CITY WA
99320
US

IV. Provider business mailing address

723 MEMORIAL ST
PROSSER WA
99350
US

V. Phone/Fax

Practice location:
  • Phone: 509-588-4075
  • Fax: 509-588-4197
Mailing address:
  • Phone: 509-786-2222
  • Fax: 509-786-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML20008180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: