MEDICARE: WALBURGA S MARTIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ML20008180	WA

General Provider Information

NPI Number	:	1053408336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALBURGA S MARTIN M.D.

Provider Business Mailing Address
First Line	:	723 MEMORIAL ST
Second Line	:
City	:	PROSSER
State	:	WA
Zip	:	99350
Country	:	US
Telephone Number	:	509-786-2222
Fax Number	:	509-786-6612

Provider Business Practice Location Address
First Line	:	701 DALE AVE
Second Line	:
City	:	BENTON CITY
State	:	WA
Zip	:	99320
Country	:	US
Telephone Number	:	509-588-4075
Fax Number	:	509-588-4197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/07/2023

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Directions to “ WALBURGA S MARTIN M.D.” Practice Location

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