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General NPI Number Information
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NPI Number | 1508201062
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Entity Type | Organization
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Legal Business Name | MARTIN MD
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 1309 SCENIC DR
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City | PROSSER
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State | WA
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Zip | 99350-1237
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Country | US
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Telephone | 509-303-9570
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 SCENIC DR
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City | PROSSER
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State | WA
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Zip | 99350-1237
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Country | US
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Telephone | 509-303-9570
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WALBURGA S MARTIN
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Credential | MD
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Telephone | 509-303-9570
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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 | MD00048680
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License Number State | WA
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