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General NPI Number Information
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NPI Number | 1194716159
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Entity Type | Individual
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Provider Name | STEVEN L MARTIN PAC
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 116 WEST BRIDGE AVENUE
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City | SARATOGA
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State | WY
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Zip | 82331
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Country | US
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Telephone | 307-329-3340
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 930
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City | SARATOGA
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State | WY
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Zip | 82331-0930
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Country | US
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Telephone | 307-329-3340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-002597
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA856
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License Number State | WY
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