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NPI Code Detail

MEDICARE: MARK ALAN MARTIN MD

MEDICARE: MARK ALAN MARTIN MD
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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianMD20553OR
2208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianMD00035549WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548252992
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ALAN MARTIN MD
Provider Business Mailing Address
First Line : 2222 NW LOVEJOY ST
Second Line : SUITE 315
City : PORTLAND
State : OR
Zip : 97210-5101
Country : US
Telephone Number : 503-266-6321
Fax Number : 503-227-3422
Provider Business Practice Location Address
First Line : 2222 NW LOVEJOY ST
Second Line : SUITE 315
City : PORTLAND
State : OR
Zip : 97210-5101
Country : US
Telephone Number : 503-266-6321
Fax Number : 503-227-3422
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 09/01/2015

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Directions to “ MARK ALAN MARTIN MD” Practice Location

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