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General NPI Number Information
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NPI Number | 1316236797
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Entity Type | Individual
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Provider Name | TREVER J. MARTIN D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 1024 E LOCUST ST
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City | EMMETT
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State | ID
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Zip | 83617
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Country | US
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Telephone | 208-365-2338
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Fax | 208-365-0677
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Provider Business Mailing Address
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Address Line | 1202 E LOCUST ST
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City | EMMETT
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State | ID
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Zip | 83617-2715
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Country | US
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Telephone | 208-365-2338
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Fax | 208-365-0677
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | P-227
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License Number State | ID
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