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General NPI Number Information
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NPI Number | 1285766469
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Entity Type | Organization
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Legal Business Name | PETER J. MARTIN
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | NORTH 115 CROSBY STREET
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City | TEKOA
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State | WA
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Zip | 99033-0629
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Country | US
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Telephone | 509-284-2423
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 629 N 115 CROSBY
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City | TEKOA
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State | WA
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Zip | 99033-0629
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Country | US
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Telephone | 509-284-2423
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ROBIN ANN HARP
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Credential |
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Telephone | 509-284-2423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 601652856
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License Number State | WA
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