Provider Demographics
NPI:1093716458
Name:LEEN, MARTHA MOTUZ (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MOTUZ
Last Name:LEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 NW MOUNT VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6000
Mailing Address - Country:US
Mailing Address - Phone:360-698-9500
Mailing Address - Fax:
Practice Address - Street 1:3260 NW MOUNT VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6000
Practice Address - Country:US
Practice Address - Phone:360-698-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00030889207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA180041110OtherRAIL ROAD MEDICARE
WA8151772Medicaid
WA2662LEOtherREGENCE BCBS
WA911013662OtherPREMERA BCBS
WA145808OtherL&I
WA145808OtherL&I
GAB19962Medicare ID - Type Unspecified
F44030Medicare UPIN